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General NPI Number Information
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NPI Number | 1174845861
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Entity Type | Organization
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Legal Business Name | BRETTHAVEN INC.
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 606 W MAIN ST STE A
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City | COOKEVILLE
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State | TN
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Zip | 38506-5395
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Country | US
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Telephone | 931-537-3211
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Fax | 931-537-9994
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Provider Business Mailing Address
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Address Line | 606 W MAIN ST STE A
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City | COOKEVILLE
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State | TN
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Zip | 38506-5395
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Country | US
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Telephone | 931-537-3211
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Fax | 931-537-9994
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Authorized Official
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Title or Position | OWNER/CEO
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Name | RACHEL LYNN CROSS
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Credential | B.S. CPHT.
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Telephone | 931-537-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 4640
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License Number State | TN
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