Organization Name: | CREEKSIDE RETREAT, INC. |
NPI Number: | 1720454614 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK ALAN MARTIN (EXECUTIVE DIRECTOR) |
Mailing Address: | 39 Stevens Hollow Rd Taft |
State: | TN US |
Postal Code: | 384885269 |
Phone Number: | 9314250589 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2015 |
NPI Last Update Date: | 02/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 16877 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | 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. |