=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093660235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY RECOVERY CENTER OF ROANE COUNTY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2026
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 E RACE ST
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37763-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-270-2323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 E RACE ST
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37763-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-270-2323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | JEFFERSON JAY HANEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-270-2323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------