NPIMap

Organization Active NPI

West Tennessee Healthcare Henry County

Doing business as Henry County Lake Haven Behavioral Health

  • Psychiatric Hospital Unit
  • Paris, TN
National Provider Identifier
1699861005
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
000000057 Issued in TN
Legal business name
WEST TENNESSEE HEALTHCARE HENRY COUNTY
Doing business as
Henry County Lake Haven Behavioral Health
Practice address
301 Tyson Ave
Paris, TN 38242-4544
Phone
(731) 642-1220
Fax
(731) 644-8587
NPI assigned
Oct 4, 2006
Last updated
Oct 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Tina Prescott
Title
Interim President and Ceo
Phone
(731) 541-6767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 000000057 TN Primary

Addresses

Primary practice location

301 Tyson Ave
Paris, TN 38242-4544

Mailing address

301 Tyson Avenue
Paris, TN 38242-4544
Phone (731) 642-1220

Other names 1

  • Henry County Lake Haven Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241025000975 TN Part A Provider - Hospital 0941731483 Practice locations: Paris, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699861005. Details of each certification follow.

Hospital certification: CCN 44S132

Legal name
WEST TENNESSEE HEALTHCARE HENRY COUNTY
Doing business as
HENRY COUNTY LAKE HAVEN BEHAVIORAL HEALTH
Organization structure
CorporationNon-profit
Enrollment address
301 Tyson Ave
Paris, TN 38242-4544
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
West Tennessee Healthcare Henry County2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Phil Bryant Individual Corporate DirectorBoard of Trustees Member Aug 1, 2024
West Tennessee Healthcare Henry County Organization, Jackson, TN Created for acquisition, Corporation, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2024 100%
Operational/Managerial Control Oct 1, 2024 100%
Jeffrey D Blankenship Individual Corporate OfficerSystem Vice President/Chief Fina Aug 1, 2024
W-2 Managing EmployeeSystem Vice President/Chief Financi Aug 1, 2024
Danny Wheeler Individual Corporate DirectorBoard of Trustees Member Aug 1, 2024
Charlotte Burch Individual Corporate DirectorBoard of Trustees Member Aug 1, 2024
Tina Prescott Individual Corporate OfficerPresident and Ceo Sep 12, 2024
W-2 Managing EmployeePresident and Ceo Sep 12, 2024
Ray Washington Individual Corporate DirectorBoard of Trustees Member Aug 1, 2024
Curtis Mansfield Individual Corporate DirectorBoard of Trustees Member Aug 1, 2024

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Tennessee Healthcare Henry County HospitalParis, TN, CCN 440132 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2024
Oct 1, 2024
West Tennessee Medical Group Primary Care Paris Henry CountyParis, TN, CCN 443469 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2024
Oct 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1699861005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 TYSON AVENUE",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424544",
            "telephone_number": "731-642-1220",
            "fax_number": "731-644-8584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 TYSON AVE",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424544",
            "telephone_number": "731-642-1220",
            "fax_number": "731-644-8587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST TENNESSEE HEALTHCARE HENRY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-10-09",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "PRESCOTT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "INTERIM PRESIDENT AND CEO",
        "authorized_official_telephone_number": "731-541-6767"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "TN",
            "license": "000000057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry County Lake Haven Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paris, TN

Sources for this page

Verify at the official NPI Registry.