| A Prodigal's Path 2 Recovery, Inc. | |
|
107 Paint Rock Ferry Rd Kingston TN 37763-2921 | |
| (865) 730-6628 | |
| (865) 730-6792 |
| Full Name | A Prodigal's Path 2 Recovery, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 107 Paint Rock Ferry Rd, Kingston, Tennessee |
| Authorized Official Name and Position | Charles Loyd Stallings (PROGRAM MANAGER) |
| Authorized Official Contact | 8657306628 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Prodigal's Path 2 Recovery, Inc. 107 Paint Rock Ferry Rd Kingston TN 37763-2921 Ph: (865) 730-6628 | A Prodigal's Path 2 Recovery, Inc. 107 Paint Rock Ferry Rd Kingston TN 37763-2921 Ph: (865) 730-6628 |
| NPI Number | 1386267490 |
|---|---|
| Provider Enumeration Date | 05/22/2020 |
| Last Update Date | 05/22/2020 |
| Certification Date | 05/22/2020 |
| Medicare PECOS PAC ID | 4486069309 |
|---|---|
| Medicare Enrollment ID | O20210226000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386267490 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Charles Loyd Stallings |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1326553637 PECOS PAC ID: 5395150213 Enrollment ID: I20210226000585 |
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