MEDICARE: TENNESSEE CLINICAL SCHOOLS, 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	323P00000X	Psychiatric Residential Treatment Facility	L2373M30369353	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215956446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE CLINICAL SCHOOLS, LLC

Provider Business Mailing Address
First Line	:	1220 8TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5004
Country	:	US
Telephone Number	:	615-742-3000
Fax Number	:	615-742-3701

Provider Business Practice Location Address
First Line	:	1220 8TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5004
Country	:	US
Telephone Number	:	615-742-3000
Fax Number	:	615-742-3701

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ETTA JETTE
Credential	:
Telephone Number	:	615-386-7232

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/01/2011

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