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General NPI Number Information
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NPI Number | 1255469227
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Entity Type | Organization
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Legal Business Name | CENTERSTONE
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 704 HIGHWAY 100 SUITE 101
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City | CENTERVILLE
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State | TN
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Zip | 37033
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Country | US
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Telephone | 931-729-3573
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Fax | 931-729-9330
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Provider Business Mailing Address
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Address Line | 704 HIGHWAY 100 SUITE 101
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City | CENTERVILLE
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State | TN
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Zip | 37033
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Country | US
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Telephone | 931-729-3573
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Fax | 931-729-9330
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MR. DAVID DALE HIGHFIELD SR.
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Credential | M.DIV
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Telephone | 931-729-3573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | LDC00000000235
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License Number State | TN
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