Organization
EAGLES NEST MENTAL HEALTH SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THELMA WILLENE JOHNSON LPC-MHSP (EXECUTIVE DIRECTOR)
(615) 915-4074
Entity
Organization
Contact information
Practice address
319 PLUS PARK BLVD, SUITE 201, NASHVILLE, TN 37217-1098
(615) 915-4074
(615) 942-6392
Mailing address
PO BOX 60895, NASHVILLE, TN 37206-0895
(615) 915-4074
(615) 942-6392
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
7929
TN
253Z00000X
In Home Supportive Care Agency
7929
TN
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
7929
TN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
7929
TN
343900000X
Non-emergency Medical Transport (VAN)
7929
TN
385H00000X
Respite Care
7929
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H42
—
TN
Enumeration date
01/28/2012
Last updated
02/01/2012
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