MEDICARE: MIDDLE TENNESSEE TREATMENT 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	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1972198380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE TENNESSEE TREATMENT CENTERS, LLC

Provider Business Mailing Address
First Line	:	6183 PASEO DEL NORTE
Second Line	:	SUITE 200
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1155
Country	:	US
Telephone Number	:	855-259-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 DONELSON PIKE
Second Line	:	STE B19
City	:	SOUTH NASHVILLE
State	:	TN
Zip	:	37217-2927
Country	:	US
Telephone Number	:	855-259-2288
Fax Number	:

Authorized Official
Title or Position	:	VP & SECRETARY
Name	:	BRIAN PHILLIP FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	10/03/2024

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