| Efc #2 | |
|
603 Amana Ave. Fayetteville TN 37334 | |
| (931) 240-0682 | |
| (931) 240-0054 |
| Full Name | Efc #2 |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 603 Amana Ave., Fayetteville, Tennessee |
| Authorized Official Name and Position | Rose L Dodge (OWNER) |
| Authorized Official Contact | 9319523499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Efc #2 603 Amana Ave. Fayetteville TN 37334 Ph: (931) 240-0682 | Efc #2 603 Amana Ave. Fayetteville TN 37334 Ph: (931) 240-0682 |
| NPI Number | 1528897451 |
|---|---|
| Provider Enumeration Date | 07/30/2024 |
| Last Update Date | 07/31/2024 |
| Certification Date | 07/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528897451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 320700000X | Residential Treatment Facility, Physical Disabilities | (* (Not Available)) | Secondary |
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