| Living Water Prevention Program Facility | |
|
959 Old Cookeville Rd Sparta TN 38583-5616 | |
| (931) 738-8102 | |
| Not Available |
| Full Name | Living Water Prevention Program Facility |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 959 Old Cookeville Rd, Sparta, Tennessee |
| Authorized Official Name and Position | Linda Caskey (SEC-TREAS) |
| Authorized Official Contact | 9317388102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Water Prevention Program Facility 959 Old Cookeville Rd Sparta TN 38583-5616 Ph: (931) 738-8102 | Living Water Prevention Program Facility 959 Old Cookeville Rd Sparta TN 38583-5616 Ph: (931) 738-8102 |
| NPI Number | 1184852048 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 06/30/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184852048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | I000000004501 (Tennessee) | Primary |
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