Organization
TEN BROECK TENNESSEE PHYSICIANS GROUP INC
Active
Organization
TEN BROECK TENNESSEE PHYSICIANS GROUP INC
Active
Other names
Center for Senior Renewal
Organization subpart
No
Provider details
NPI number
Authorized official
GLENDA F GUY (DIRECTOR, COMPLIANCE)
(931) 783-2511
Entity
Organization
Contact information
Practice address
802 N 8TH ST, VANDALIA, IL 62471-1756
(618) 283-1731
(618) 283-0590
Mailing address
1 MEDICAL CENTER BLVD, COOKEVILLE, TN 38501-4294
(931) 783-2511
(931) 783-2550
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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