Healthcare Provider Details

I. General information

NPI: 1144672411
Provider Name (Legal Business Name): WOODRIDGE BEHAVIORAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 CUDE LN
MADISON TN
37115-2202
US

IV. Provider business mailing address

162 CUDE LN
MADISON TN
37115-2202
US

V. Phone/Fax

Practice location:
  • Phone: 615-860-9230
  • Fax:
Mailing address:
  • Phone: 615-860-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL D. WHITE
Title or Position: CFO
Credential:
Phone: 615-860-9230