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General NPI Number Information
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NPI Number | 1295007839
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Entity Type | Organization
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Legal Business Name | EAGLES NEST MENTAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 01/28/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 319 PLUS PARK BLVD SUITE 201
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City | NASHVILLE
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State | TN
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Zip | 37217-1098
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Country | US
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Telephone | 615-915-4074
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Fax | 615-942-6392
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Provider Business Mailing Address
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Address Line | PO BOX 60895
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City | NASHVILLE
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State | TN
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Zip | 37206-0895
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Country | US
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Telephone | 615-915-4074
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Fax | 615-942-6392
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. THELMA WILLENE JOHNSON
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Credential | LPC-MHSP
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Telephone | 615-915-4074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 7929
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 7929
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 7929
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 7929
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 7929
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 7929
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License Number State | TN
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