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NPI Code Detail

MEDICARE: LA PALOMA TREATMENT CENTER, LLC

MEDICARE: LA PALOMA TREATMENT 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)I 2(14)M2-077-9751TN
2261QM0850XAdult Mental Health Clinic/CenterL 2(14)M3-017-6472TN
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center0000000109TN
4261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center0000000032TN
5323P00000XPsychiatric Residential Treatment FacilityL 217-017-6471TN
6324500000XSubstance Abuse Rehabilitation Facility0000000109TN
7320800000XMental Illness Community Based Residential Treatment FacilityL000000010053TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13105734OTHERTNBCBST PROVIDER ID

General Provider Information

NPI Number : 1689674368
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA PALOMA TREATMENT CENTER, LLC
Provider Business Mailing Address
First Line : 1000 HEALTH PARK DRIVE
Second Line : BUILDING THREE, SUITE 400
City : BRENTWOOD
State : TN
Zip : 37027
Country : US
Telephone Number : 615-386-7255
Fax Number : 615-645-7445
Provider Business Practice Location Address
First Line : 2009 LAMAR AVENUE
Second Line :
City : MEMPHIS
State : TN
Zip : 38114-2138
Country : US
Telephone Number : 615-345-3217
Fax Number : 615-373-4656
Authorized Official
Title or Position : EVP-CHIEF FINANCIAL OFFICER
Name : STEVE FILTON
Credential :
Telephone Number : 610-382-3319
Provider Enumeration Date : 07/26/2005
Last Update Date : 05/20/2019

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Directions to “LA PALOMA TREATMENT CENTER, LLC ” Practice Location

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