MEDICARE: CENTRAL RECOVERY TREATMENT 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1922743020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL RECOVERY TREATMENT LLC

Provider Business Mailing Address
First Line	:	720 COOL SPRINGS BLVD STE 500
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3351 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6283
Country	:	US
Telephone Number	:	702-786-4268
Fax Number	:

Authorized Official
Title or Position	:	CONTRACTING SPECIALIST
Name	:	ALICIA NEAL
Credential	:
Telephone Number	:	615-281-9050

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	06/15/2023

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