| 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 |
|---|---|
| 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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