MEDICARE: RAPHA CENTERS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1689052672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPHA CENTERS LLC

Provider Business Mailing Address
First Line	:	405 STEAM PLANT RD
Second Line	:	STE. 200
City	:	GALLATIN
State	:	TN
Zip	:	37066-3027
Country	:	US
Telephone Number	:	615-829-5700
Fax Number	:	615-661-4357

Provider Business Practice Location Address
First Line	:	405 STEAM PLANT RD
Second Line	:	STE. 200
City	:	GALLATIN
State	:	TN
Zip	:	37066-3027
Country	:	US
Telephone Number	:	615-829-5700
Fax Number	:	615-661-4357

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN MARCY
Credential	:
Telephone Number	:	615-829-5700

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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