Healthcare Provider Details

I. General information

NPI: 1164012068
Provider Name (Legal Business Name): BEHAVIORAL HEALTH OF ROCKY TOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 INDUSTRIAL PARK LN
ROCKY TOP TN
37769-2301
US

IV. Provider business mailing address

210 INDUSTRIAL PARK LN
ROCKY TOP TN
37769-2301
US

V. Phone/Fax

Practice location:
  • Phone: 865-392-9200
  • Fax:
Mailing address:
  • Phone: 865-392-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN HARRELL
Title or Position: AR MANAGER
Credential:
Phone: 865-218-8966