NPIMap

Organization Active NPI

Fortwood Center, Inc.

  • Community/Behavioral Health Agency
  • Chattanooga, TN
National Provider Identifier
1881821056
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
FORTWOOD CENTER, INC.
Practice address
1411 Bailey Ave
Chattanooga, TN 37404-2904
Phone
(423) 266-6751
Fax
(423) 763-4650
NPI assigned
Jun 16, 2009
Last updated
Jun 16, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MENTAL HEALTH CENTERS & CLINICS OF FORTWOOD CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

1411 Bailey Ave
Chattanooga, TN 37404-2904

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
3399761MedicaidTN

Other names 1

  • Mitchell Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Mental Health Centers C5 organizations share this tax ID, including this one
Part of
Mental Health Centers C

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1881821056",
    "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": "423-763-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 BAILEY AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374042904",
            "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3399761",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchell Home",
            "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.