NPIMap

Organization Active NPI

Fortwood Center, Inc.

  • Community/Behavioral Health Agency
  • Chattanooga, TN
National Provider Identifier
1366679409
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
L000000003950 Issued in TN
Legal business name
FORTWOOD CENTER, INC.
Practice address
1508 Old Ringgold Rd
Chattanooga, TN 37404-5444
Phone
(423) 266-6751
Fax
(423) 763-4650
NPI assigned
Jun 16, 2009
Organization subpart
Yes
Parent organization
MENTAL HEALTH CENTERS & CLINICS OF FORTWOOD CENTER, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Mrs. Melissa Queen-Pennington
Title
Cfo
Phone
(423) 266-6751

Corporate family (same tax ID) 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory
Tax ID family
Mental Health Centers C (5 organizations share this tax ID)
Part of
Mental Health Centers C

Locations

1028 E 3rd St
Chattanooga, TN 37403
Phone (423) 763-4630

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X L000000003950 TN Primary

Addresses

NPPES NPI Registry

Primary practice location

1508 Old Ringgold Rd
Chattanooga, TN 37404-5444

Mailing address

1028 E 3Rd St
Chattanooga, TN 37403-2107
Phone (423) 266-6751

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
3399761MedicaidTN

Other names 1

NPPES NPI Registry
  • Rosewood 4 Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 16, 2009.

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1366679409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 E 3RD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032107",
            "telephone_number": "423-266-6751",
            "fax_number": "423-266-6751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 OLD RINGGOLD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374045444",
            "telephone_number": "423-266-6751",
            "fax_number": "423-763-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTWOOD CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MENTAL HEALTH CENTERS & CLINICS OF FORTWOOD CENTER, INC.",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "QUEEN-PENNINGTON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "423-266-6751",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TN",
            "license": "L000000003950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3399761",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosewood 4",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.