Healthcare Provider Details

I. General information

NPI: 1619368842
Provider Name (Legal Business Name): COMMUNITY CARE HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 CHURCH ST STE 220
NASHVILLE TN
37219-2464
US

IV. Provider business mailing address

424 CHURCH ST STE 2600
NASHVILLE TN
37219-2379
US

V. Phone/Fax

Practice location:
  • Phone: 877-564-3627
  • Fax: 877-561-7566
Mailing address:
  • Phone: 877-564-3627
  • Fax: 877-561-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE PETERSON
Title or Position: MANAGER
Credential:
Phone: 877-564-3627