Provider Demographics
NPI:1538498555
Name:EMMANUEL TREATMENT CENTER
Entity type:Organization
Organization Name:EMMANUEL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:MOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-231-5905
Mailing Address - Street 1:2773 HIGHWAY 43 N
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-6057
Mailing Address - Country:US
Mailing Address - Phone:931-231-5514
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ETHRIDGE
Practice Address - State:TN
Practice Address - Zip Code:38456
Practice Address - Country:US
Practice Address - Phone:931-231-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000005014322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children