Rivendell Center Llc | |
216 Fairview Dr Maryville TN 37803-0537 | |
(865) 681-4914 | |
(865) 977-9573 |
Full Name | Rivendell Center Llc |
---|---|
Speciality | Social Worker - Clinical |
Location | 216 Fairview Dr, Maryville, Tennessee |
Authorized Official Name and Position | Patricia L Gallagher (OWNER MANAGER) |
Authorized Official Contact | 8656814914 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Rivendell Center Llc 120 Wilson Ave Maryville TN 37803-6051 Ph: (865) 681-4914 | Rivendell Center Llc 216 Fairview Dr Maryville TN 37803-0537 Ph: (865) 681-4914 |
NPI Number | 1720097975 |
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Provider Enumeration Date | 08/05/2006 |
Last Update Date | 10/04/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720097975 | NPI | - | NPPES |
3922162 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | LSW0000003963 (Tennessee) | Primary |
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