Organization
DICKSON RECOVERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN CHRISTOPHER JACKSON (MANAGING MEMBER)
(615) 560-2130
Entity
Organization
Contact information
Practice address
222 CHURCH ST, DICKSON, TN 37055-1304
(615) 560-2130
Mailing address
222 CHURCH ST, DICKSON, TN 37055-1304
(615) 560-2130
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
I 237-106-9373
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5441046
—
TN
Enumeration date
01/08/2007
Last updated
08/14/2008
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