Provider Demographics
NPI:1598576019
Name:CEDAR RECOVERY OTP, LLC
Entity type:Organization
Organization Name:CEDAR RECOVERY OTP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:TRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-914-1518
Mailing Address - Street 1:5000 CROSSINGS CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8591
Mailing Address - Country:US
Mailing Address - Phone:615-553-1322
Mailing Address - Fax:615-549-7044
Practice Address - Street 1:4409 CHAPMAN HWY STE W
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4326
Practice Address - Country:US
Practice Address - Phone:615-553-1322
Practice Address - Fax:615-549-7044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR RECOVERY CENTER OF MIDDLE TENNESSEE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone