Healthcare Provider Details

I. General information

NPI: 1770153769
Provider Name (Legal Business Name): TULIP HILL RECOVERY OF JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W BALTIMORE ST
JACKSON TN
38301-6136
US

IV. Provider business mailing address

228 W BALTIMORE ST
JACKSON TN
38301-6136
US

V. Phone/Fax

Practice location:
  • Phone: 615-892-0838
  • Fax:
Mailing address:
  • Phone: 615-892-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN TYLER JONES
Title or Position: CEO
Credential: MS
Phone: 615-892-0838