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CRC HEALTH TENNESSEE LLC NPI 1770615619


NPI Information

NPI: 1770615619
Provider Name: CRC HEALTH TENNESSEE, LLC

Doing Business As: MIRROR LAKE RECOVERY CENTER

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 44D2032797

Address:
999 GIRL SCOUT RD
BURNS, TN
ZIP 37029
Phone: (615) 446-7034
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CRC HEALTH TENNESSEE, LLC is a substance abuse rehabilitation facility in Burns, TN. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. CRC HEALTH TENNESSEE, LLC NPI is 1770615619. The provider is registered as an organization entity type.
The provider Is Doing Business As Mirror Lake Recovery Center.

The provider's business location address is:

999 GIRL SCOUT RD
BURNS, TN
ZIP 37029
Phone: (615) 446-7034
Fax: (615) 446-7061

The provider's authorized official is Brian P Farley .
The authorized official title is Vp & Secretary and has the following contact phone number (615) 861-6000.

The CLIA number assigned to this NPI record is 44D2032797 - other - residential treatment fac with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/9/2007 and was last updated on 8/28/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0401XClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)7378TENNESSEENo
2324500000XSubstance Abuse Rehabilitation Facility0000000116TENNESSEENo
3324500000XSubstance Abuse Rehabilitation Facility7378TENNESSEEYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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