Healthcare Provider Details

I. General information

NPI: 1477727824
Provider Name (Legal Business Name): CENTERSTONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W 7TH ST
COLUMBIA TN
38401-3135
US

IV. Provider business mailing address

418 W 7TH ST
COLUMBIA TN
38401-3135
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-0078
  • Fax: 931-388-0866
Mailing address:
  • Phone: 931-388-0078
  • Fax: 931-388-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM TRAVIS EDWARDS
Title or Position: COUNSELOR
Credential:
Phone: 931-223-5840