Provider Demographics
NPI:1144324831
Name:BEHAVIORAL HEALTHCARE CENTER AT MARTIN LLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTHCARE CENTER AT MARTIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-595-8383
Mailing Address - Street 1:P.O, BOX 10
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-0010
Mailing Address - Country:US
Mailing Address - Phone:731-847-6343
Mailing Address - Fax:731-847-4201
Practice Address - Street 1:458 HANNINGS LANE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237
Practice Address - Country:US
Practice Address - Phone:731-588-2830
Practice Address - Fax:731-587-6923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH COMPANIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
TNL2160466176283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0444005Medicaid
TN4110035OtherBLUE CROSS BLUE SHIELD
TN103I264764Medicare PIN
TN0444005Medicaid
TN4110035OtherBLUE CROSS BLUE SHIELD
TN444005Medicare Oscar/Certification