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General NPI Number Information
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NPI Number | 1699926386
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Entity Type | Organization
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Legal Business Name | WOODRIDGE OF TENNESSEE, LLC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 49 OLD HICKORY BLVD
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City | JACKSON
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State | TN
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Zip | 38305-4551
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Country | US
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Telephone | 731-668-5880
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Fax | 731-668-5870
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Provider Business Mailing Address
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Address Line | 2520 NORTHWINDS PKWY STE 550
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City | ALPHARETTA
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State | GA
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Zip | 30009-2236
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Country | US
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Telephone | 470-554-7903
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Fax | 470-300-7566
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATIVE SERVICES
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Name | ROCHELLE GERBER
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Credential |
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Telephone | 470-554-7903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | L000000002976
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License Number State | TN
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