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General NPI Number Information
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NPI Number | 1598576019
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Entity Type | Organization
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Legal Business Name | CEDAR RECOVERY OTP, LLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 4409 CHAPMAN HWY STE W
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City | KNOXVILLE
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State | TN
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Zip | 37920-4326
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Country | US
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Telephone | 615-553-1322
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Fax | 615-549-7044
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Provider Business Mailing Address
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Address Line | 5000 CROSSINGS CIR STE 103
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City | MOUNT JULIET
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State | TN
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Zip | 37122-8591
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Country | US
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Telephone | 615-553-1322
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Fax | 615-549-7044
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Authorized Official
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Title or Position | CHIEF STRATEGY OFFICER
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Name | PAUL STEPHEN TRIVETTE
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Credential |
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Telephone | 423-914-1518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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