MEDICARE: SAMARITAN RECOVERY COMMUNITY, INC.

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	324500000X	Substance Abuse Rehabilitation Facility		TN

General Provider Information

NPI Number	:	1053303305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN RECOVERY COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	319 S 4TH ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-4103
Country	:	US
Telephone Number	:	615-244-4802
Fax Number	:	615-242-1459

Provider Business Practice Location Address
First Line	:	319 S 4TH ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-4103
Country	:	US
Telephone Number	:	615-244-4802
Fax Number	:	615-242-1459

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOHN YORK
Credential	:
Telephone Number	:	615-244-4802

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/21/2022

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