Organization
DETOX WEST TENNESSEE LLC
Active
Other names
Brentwood Springs Detox
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILSON PRUITT (DIRECTOR)
(615) 969-8612
Entity
Organization
Contact information
Practice address
370 N CUMBERLAND ST, JACKSON, TN 38301-5470
(615) 969-8612
Mailing address
370 N CUMBERLAND ST, JACKSON, TN 38301-5470
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
971960
DOB
TN
Enumeration date
09/21/2020
Last updated
09/21/2020
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