Healthcare Provider Details

I. General information

NPI: 1275672685
Provider Name (Legal Business Name): PREFERRED ALTERNATIVES OF TN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VANTAGE WAY STE 100
NASHVILLE TN
37228-1515
US

IV. Provider business mailing address

PO BOX 44105
FAYETTEVILLE NC
28309-4105
US

V. Phone/Fax

Practice location:
  • Phone: 615-259-0175
  • Fax: 615-259-3770
Mailing address:
  • Phone: 910-483-5744
  • Fax: 910-483-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberL3(20)4M5-085-3042
License Number StateTN

VIII. Authorized Official

Name: JAMES R WILSON JR.
Title or Position: PRESIDENT & CEO
Credential:
Phone: 910-483-5744