Organization
RHA/TRENTON MR,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY BOONE (ADMINISTRATOR)
(731) 855-0537
Entity
Organization
Contact information
Practice address
2055 US HIGHWAY 45 BYP S, TRENTON, TN 38382-3501
(731) 855-0537
Mailing address
PO BOX 106, TRENTON, TN 38382-0106
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7447036
ICF/MR PROVIDER NUMBER
TN
Enumeration date
08/10/2005
Last updated
08/22/2020
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