Healthcare Provider Details

I. General information

NPI: 1871241281
Provider Name (Legal Business Name): PARK CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 BATAVIA ST # BC
NASHVILLE TN
37209-2636
US

IV. Provider business mailing address

1935 21ST AVE S
NASHVILLE TN
37212-3997
US

V. Phone/Fax

Practice location:
  • Phone: 615-242-3576
  • Fax:
Mailing address:
  • Phone: 615-242-3576
  • 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: AMY MADEN
Title or Position: CFO
Credential:
Phone: 615-242-3576