Healthcare Provider Details

I. General information

NPI: 1043685563
Provider Name (Legal Business Name): CENTERSTONE OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 HART LN
NASHVILLE TN
37216-2007
US

IV. Provider business mailing address

717 HART LN
NASHVILLE TN
37216-2007
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-4290
  • Fax:
Mailing address:
  • Phone: 615-460-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DWAYNE LARVEL RICKETTS
Title or Position: RESIDENTIAL COUNSELOR
Credential:
Phone: 615-460-4290