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General NPI Number Information
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NPI Number | 1255199949
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Entity Type | Organization
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Legal Business Name | BROKEN HEALER HOME
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 2423 CEDAR CREEK DR
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2006
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Country | US
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Telephone | 423-242-8551
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 RYNES RD
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City | DECATUR
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State | TN
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Zip | 37322-7420
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Country | US
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Telephone | 423-242-8551
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NIRVA ACHE
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Credential |
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Telephone | 423-242-8551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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