Organization
STATE OF TENNESSEE
Active
Organization
STATE OF TENNESSEE
Active
Other names
Lakeshore Mental Health Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD L THOMAS (CHIEF EXECUTIVE OFFICER - CEO)
(865) 583-8888
Entity
Organization
Contact information
Practice address
5908 LYONS VIEW PIKE, KNOXVILLE, TN 37919
(865) 584-1561
(865) 450-5203
Mailing address
5908 LYONS VIEW PIKE, KNOXVILLE, TN 37919
(865) 584-1561
(865) 450-5203
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
L2161051102
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010800
BCBS
TN
05
—
0444000
—
TN
01
—
3282144
CIGNA MEDICARE PART B
TN
Enumeration date
10/27/2006
Last updated
03/20/2012
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