Healthcare Provider Details

I. General information

NPI: 1134372162
Provider Name (Legal Business Name): COMPREHENSIVE COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 1/2 WESLEY ST SUITE 5
JOHNSON CITY TN
37601-1752
US

IV. Provider business mailing address

2514 1/2 WESLEY ST SUITE 5
JOHNSON CITY TN
37601-1752
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-6581
  • Fax: 423-928-6215
Mailing address:
  • Phone: 423-928-6581
  • Fax: 423-928-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1000000002949
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1000000002949
License Number StateTN

VIII. Authorized Official

Name: MR. REVE MCDAVID
Title or Position: PRESIDENT
Credential:
Phone: 423-928-6581