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NPI Code Detail

MEDICARE: BRADLEY CLEVELAND REHAB SERVICES

MEDICARE: BRADLEY CLEVELAND REHAB SERVICES
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
1251S00000XCommunity/Behavioral Health AgencyL214-117-2195TN
2251S00000XCommunity/Behavioral Health AgencyLPC0000000694TN

General Provider Information

NPI Number : 1578741898
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRADLEY CLEVELAND REHAB SERVICES
Provider Business Mailing Address
First Line : 423 CENTRAL AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-4923
Country : US
Telephone Number : 423-476-1933
Fax Number : 423-559-1848
Provider Business Practice Location Address
First Line : 423 CENTRAL AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-4923
Country : US
Telephone Number : 423-476-1933
Fax Number : 423-559-1848
Authorized Official
Title or Position : CHAIRMAN OF BOARD
Name : MR. JOHN KIE VINING
Credential : DMIN, LPC
Telephone Number : 423-476-1933
Provider Enumeration Date : 02/08/2008
Last Update Date : 01/05/2017

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Directions to “BRADLEY CLEVELAND REHAB SERVICES ” Practice Location

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