Healthcare Provider Details

I. General information

NPI: 1730892837
Provider Name (Legal Business Name): BLUEBIRD RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 LEDFORD MILL RD STE B
TULLAHOMA TN
37388-2278
US

IV. Provider business mailing address

127 LEDFORD MILL RD STE B
TULLAHOMA TN
37388-2278
US

V. Phone/Fax

Practice location:
  • Phone: 931-841-3311
  • Fax: 931-841-3314
Mailing address:
  • Phone: 931-841-3311
  • Fax: 931-841-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHASITY J TANKERSLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-841-3311