Healthcare Provider Details

I. General information

NPI: 1124861406
Provider Name (Legal Business Name): CEDAR RECOVERY OF MIDDLE TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 PERIMETER PLACE DR STE 105
NASHVILLE TN
37214-3674
US

IV. Provider business mailing address

5000 CROSSINGS CIR STE 103
MOUNT JULIET TN
37122-8591
US

V. Phone/Fax

Practice location:
  • Phone: 615-257-6844
  • Fax: 615-549-7044
Mailing address:
  • Phone: 615-257-6844
  • Fax: 615-549-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL STEPHEN TRIVETTE
Title or Position: CHIEF STRATEGY OFFICER
Credential:
Phone: 423-914-1518