| Organization Name: | EAGLES NEST MENTAL HEALTH SERVICES INC |
| NPI Number: | 1295007839 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THELMA WILLENE JOHNSON (EXECUTIVE DIRECTOR) |
| Mailing Address: | 319 Plus Park Blvd Suite 201 Nashville |
| State: | TN US |
| Postal Code: | 372171098 |
| Phone Number: | 6159154074 |
| Fax Number: | 6159426392 |
| NPI Enumeration Date: | 01/28/2012 |
| NPI Last Update Date: | 02/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320900000X |
| License Number: | 7929 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |