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Organization

FAIRHAVEN TREATMENT CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA ANN GRAY (BUSINESS MANAGER)
(901) 757-7979
Entity
Organization

Contact information

Practice address
890 N HOUSTON LEVEE RD, CORDOVA, TN 38018-6614
(901) 757-7979
Mailing address
890 N HOUSTON LEVEE RD, CORDOVA, TN 38018-6614
(901) 757-7979

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
14387
TN
261QM0850X
Adult Mental Health Clinic/Center
14387
TN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
14387
TN

Other

Enumeration date
03/11/2015
Last updated
03/11/2015
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