CRC Health Tennessee, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

7378 Issued in TN

Legal business name

CRC HEALTH TENNESSEE, LLC

Doing business as

Mirror Lake Recovery Center

Practice address

999 Girl Scout Rd
Burns, TN 37029

Phone

(615) 446-7034

Fax

(615) 446-7061

NPI assigned

Mar 9, 2007

Last updated

Aug 28, 2023By 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

Brian P Farley

Title

VP & Secretary

Phone

(615) 861-6000

Specialties & licenses 3

Addresses

Other names 1

• Mirror Lake Recovery Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

CRC Health Tennessee Inc2 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.

• CRC Health Tennessee, Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Cookeville, TN
  • NPI 1215230693
  NPD tax ID

Locations

Practitioners 2

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.

• Chad David Elkin, M.D.

  • Addiction Medicine (Preventive Medicine) Physician
  • Brentwood, TN
  • NPI 1497970636
  NPD (past)
• Louis Reginald Lerebours Jr., MD

  • Addiction Medicine (Family Medicine) Physician
  • Nashville, TN
  • NPI 1851821649
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1770615619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 TOWER CIR STE 1000",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370671509",
            "telephone_number": "615-861-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 GIRL SCOUT RD",
            "city": "BURNS",
            "state": "TN",
            "postal_code": "37029",
            "telephone_number": "615-446-7034",
            "fax_number": "615-446-7061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRC HEALTH TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP & SECRETARY",
        "authorized_official_telephone_number": "615-861-6000"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "TN",
            "license": "7378",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "TN",
            "license": "0000000116",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "TN",
            "license": "7378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mirror Lake Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shaquita Bonds, FNP
• Will Campbell, MA, MBA, LADAC II
• James Robert Chatham II, LPC MHSP
• Chatterbox Speech Therapy PLLC
• Shirley Beth Clemence, CPM
• Brian Dalton, D.D.S.
• Elite Caregiving Services LLC
• Melvin Leslie Elson, MD
• Marcie Hadley
• Rebecca Hill, PMHNP

• Substance Abuse Rehabilitation Facility in Burns, TN
• Providers in Burns, TN by specialty
• Substance Abuse Rehabilitation Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.