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General NPI Number Information
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NPI Number | 1285775874
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Entity Type | Organization
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Legal Business Name | CLOVER BOTTOM DEV. CENTER
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 275 STEWARTS FERRY PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3325
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Country | US
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Telephone | 615-231-5372
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Fax | 615-231-5121
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Provider Business Mailing Address
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Address Line | 275 STEWARTS FERRY PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3325
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Country | US
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Telephone | 615-231-5372
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Fax | 615-231-5121
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | DR. LEVI HARRIS
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Credential |
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Telephone | 615-231-5372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | L 323-096-3521
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License Number State | TN
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