Healthcare Provider Details

I. General information

NPI: 1629259130
Provider Name (Legal Business Name): LA PALOMA TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 LA PALOMA STREET
MEMPHIS TN
38114-2022
US

IV. Provider business mailing address

1000 HEALTH PARK DRIVE BUILDING THREE, SUITE 400
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-3217
  • Fax: 615-373-4656
Mailing address:
  • Phone: 615-386-7255
  • Fax: 615-645-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number0000000109
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberL000000010052
License Number StateTN

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: EVP-CHIEF FINANCIAL OFFICER
Credential:
Phone: 610-382-3319