MEDICARE: CHATTANOOGA RECOVERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I000000026781	OTHER	TN	STATE OF TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

General Provider Information

NPI Number	:	1043828668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATTANOOGA RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	13 W KENT ST STE 201
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-9913
Country	:	US
Telephone Number	:	423-226-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 W KENT ST STE 201
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-9913
Country	:	US
Telephone Number	:	423-226-5331
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	BRETT ARIC NELSON
Credential	:	MD
Telephone Number	:	423-208-9367

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	12/22/2021

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