Healthcare Provider Details

I. General information

NPI: 1356770648
Provider Name (Legal Business Name): MARGARET CASDORPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 RANSOM PL
NASHVILLE TN
37217-3841
US

IV. Provider business mailing address

1424 JANET WAY DR
CLARKSVILLE TN
37042-6722
US

V. Phone/Fax

Practice location:
  • Phone: 615-463-6652
  • Fax:
Mailing address:
  • Phone: 931-561-1000
  • 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:
Title or Position:
Credential:
Phone: