Eagles Passage Therapeutic Farm, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LSW0000004526 Issued in TN

Legal business name

EAGLES PASSAGE THERAPEUTIC FARM, LLC

Practice address

2605 Riddle Rd
New Market, TN 37820-4835

Phone

(865) 932-3331

Fax

(865) 932-3331

NPI assigned

Oct 17, 2008

Last updated

Dec 9, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Lynn Frady, LCSWNPI 1407806284

Title

Member/Clinical Director

Phone

(865) 932-3331

Specialties & licenses 1

Addresses

Other identifiers 5

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Lynn Frady, L.C.S.W.

  • Clinical Social Worker
  • Portland, TN
  • NPI 1407806284
  NPD (past) Authorized official

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1427200757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 RIDDLE RD",
            "city": "NEW MARKET",
            "state": "TN",
            "postal_code": "378204835",
            "telephone_number": "865-932-3331",
            "fax_number": "865-932-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 RIDDLE RD",
            "city": "NEW MARKET",
            "state": "TN",
            "postal_code": "378204835",
            "telephone_number": "865-932-3331",
            "fax_number": "865-932-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLES PASSAGE THERAPEUTIC FARM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-17",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "FRADY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "MEMBER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "865-932-3331",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW0000004526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA-MILITARY",
            "identifier": "263470730",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "264470000",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2088872",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5389124",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4208400",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Joseph Baldwin, D.C.
• Bio-Medical Applications of Tennessee, Inc. (Fresenius Medical Care New Market)
• Called to Care LLC
• Cornerstone Family Practice, Inc.
• Drew Day, PA-C
• Savannah Renee Hartman, CPM
• Rachael Noel Kopaceski, DOULA
• Labworx, LLC
• Tammy Loy
• Juli Renee Nagashima, PMHNP-BC

• Clinical Social Worker in New Market, TN
• Providers in New Market, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.