Premiercare Tennessee Inc

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

I000000011394 Issued in TN

Legal business name

PREMIERCARE TENNESSEE INC

Practice address

1 Medical Center Blvd
5 West
Cookeville, TN 38501-4294

Phone

(931) 783-2570

Fax

(931) 783-2579

NPI assigned

Jun 25, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Corddry

Title

Chief Financial Officer

Phone

(407) 876-2200

Specialties & licenses 2

Addresses

Other names 1

• Ten Broeck Tennessee Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 444022

Legal name

TEN BROECK TENNESSEE

Certification status

Terminated Voluntary: merger or closure, Aug 28, 2020

Provider type (POS)

Hospital – Psychiatric

Participating since

Nov 20, 2012

Last certification

Oct 14, 2015

Beds

32

Ownership / control type

Private (for profit)

Facility address

1 Medical Center Blvd 5 West
Cookeville, TN 38501

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1194088112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 MAIN ST",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347863548",
            "telephone_number": "407-876-2200",
            "fax_number": "407-876-3065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "address_2": "5 WEST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014294",
            "telephone_number": "931-783-2570",
            "fax_number": "931-783-2579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERCARE TENNESSEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "CORDDRY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "407-876-2200"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "TN",
            "license": "I000000011394",
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "TN",
            "license": "I000000012016",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ten Broeck Tennessee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jana Price, M.ED.,SLP.CCC
• Providence Health Solutions LLC
• Madelaine Pruitt, CRNA

• Psychiatric Hospital in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Psychiatric Hospital in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.