Organization
JEFFERSON TRAIL TREATMENT CENTER FOR CHILDREN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI TENCH BOD (BUSINESS OFFICE DIRECTOR)
(615) 250-0283
Entity
Organization
Contact information
Practice address
2101 ARLINGTON BLVD, CHARLOTTESVILLE, VA 22903-1521
(615) 250-0283
(615) 250-0000
Mailing address
110 WESTWOOD PL, SUITE 100, BRENTWOOD, TN 37027-5075
(615) 250-0283
(615) 250-0000
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
63014001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000207306
—
VA
Enumeration date
06/30/2011
Last updated
06/30/2011
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