Organization
OPEN HOME TRANSITIONAL LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BURNS JACKSON (OWNER)
(615) 668-3917
Entity
Organization
Contact information
Practice address
6010 CORTEZ CT, HERMITAGE, TN 37076-2404
(615) 668-3917
Mailing address
6010 CORTEZ CT, HERMITAGE, TN 37076-2404
(615) 668-3917
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
I0000000010203
TN
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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