Healthcare Provider Details

I. General information

NPI: 1285238824
Provider Name (Legal Business Name): RESURGENCE TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WILLIAM D JONES BLVD
FAYETTEVILLE TN
37334-2730
US

IV. Provider business mailing address

3151 AIRWAY AVE STE M1
COSTA MESA CA
92626-4626
US

V. Phone/Fax

Practice location:
  • Phone: 888-700-5053
  • Fax:
Mailing address:
  • Phone: 949-244-5481
  • Fax: 949-209-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMIE LITTLETON
Title or Position: NATIONAL CLINICAL DIRECTOR
Credential: LMFT #122999
Phone: 949-244-5481