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General NPI Number Information
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NPI Number | 1255821310
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 375 USELTON ROAD
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City | SHELBYVILLE
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State | TN
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Zip | 37160
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Country | US
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Telephone | 931-684-5666
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Fax | 931-684-0300
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Provider Business Mailing Address
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Address Line | 375 USELTON ROAD 375 USELTON ROAD
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City | SHELBYVILLE
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State | TN
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Zip | 37160
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Country | US
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Telephone | 931-684-5666
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Fax | 931-684-0300
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RODNEY T. THOMPSON
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Credential |
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Telephone | 931-684-5666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | L000000020335
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License Number State | TN
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