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General NPI Number Information
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NPI Number | 1942382270
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Entity Type | Organization
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Legal Business Name | CLOVER BOTTOM DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 10/19/2006
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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 | 615-231-5065
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Fax | 615-231-5316
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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 |
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Fax | 615-231-5316
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | MR. CHARLES CASS
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Credential |
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Telephone | 615-231-5528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 856
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License Number State | TN
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