Organization
PREMIERCARE TENNESSEE INC
Active
Other names
Ten Broeck Tennessee
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CORDDRY (CHIEF FINANCIAL OFFICER)
(407) 876-2200
Entity
Organization
Contact information
Practice address
1 MEDICAL CENTER BLVD, 5 WEST, COOKEVILLE, TN 38501-4294
(931) 783-2570
(931) 783-2579
Mailing address
603 MAIN ST, WINDERMERE, FL 34786-3548
(407) 876-2200
(407) 876-3065
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
I000000011394
TN
283Q00000X
Psychiatric Hospital
I000000012016
TN
Other
Enumeration date
06/25/2012
Last updated
01/10/2013
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