# JEFFERSON TRAIL TREATMENT CENTER FOR CHILDREN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922395748
- **Authorized official:** VICKI TENCH BOD (BUSINESS OFFICE DIRECTOR)
- **Authorized official phone:** (615) 250-0283

## Contact information

- **Practice address:** 2101 ARLINGTON BLVD, CHARLOTTESVILLE, VA 22903-1521
- **Practice address phone:** (615) 250-0283
- **Practice address fax:** (615) 250-0000
- **Mailing address:** 110 WESTWOOD PL, SUITE 100, BRENTWOOD, TN 37027-5075
- **Mailing address phone:** (615) 250-0283
- **Mailing address fax:** (615) 250-0000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | 63014001 | VA | Yes |

## Other

- **Enumeration date:** 06/30/2011
- **Last updated:** 06/30/2011