CASSANDRA WOODRUFF YOUTH CENTER (NPI# 1164417465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164417465 |
| Entity Type | Organization |
| Organization Name | CASSANDRA WOODRUFF YOUTH CENTER |
| Practice Address |
605 Hemphill Cir Chattanooga TN 37411-2912 |
| Mailing Address |
2711 Benton Ave Chattanooga TN 37406-3621 |
| Practice Telephone | 4236980229 |
| Mailing Telephone | 4234931867 |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CASSANDRA WOODRUFF (DIRECTOR) |
| Authorized Official Telephone | 4234931867 |
| Authorized Official Credential | M.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | SO/CO286 | TN | Residential Treatment Facilities |
| Street Address |
605 HEMPHILL CIR |
| City | CHATTANOOGA |
| State | TN |
| Zip Code | 37411-2912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811520620 | Winzetta Jenkins | Social Worker | 5705 Uptain Rd., Chattanooga, TN 37411 | 2020-02-20 |
| 1881156651 | Valerie L Radu | Social Worker | 5800 Uptain Road, Suite 1200, Chattanooga, TN 37411 | 2019-04-02 |
| 1568986693 | Solution Transportation Services, Inc | Non-emergency Medical Transport (VAN) | 4707 North Terrace, Chattanooga, TN 37411 | 2017-07-31 |
| 1689060733 | Nirlepkumar Patel | Pharmacist | 3602 Brainerd Road, Chattanooga, TN 37411 | 2015-04-15 |
| 1669896254 | Audra Valentaviciene | Nurse Practitioner | 5618 Brainerd Road, Chattanooga, TN 37411 | 2014-02-18 |
| 1376973198 | Kelly Leigh Kennedy | Nurse Practitioner | 5600 Brainerd Road, Suite B14, Chattanooga, TN 37411 | 2013-11-14 |
| 1417210071 | Jason Owen Blair | Physical Therapy Assistant | 5779 Brainard Rd, Chattanooga, TN 37411 | 2012-06-19 |
| 1447532270 | Masons and Daughter LLC | Non-emergency Medical Transport (VAN) | 7 North Tuxedo Ave, Chattanooga, TN 37411 | 2011-09-19 |
| 1841500386 | Pamela Denise Stultz | Physical Therapy Assistant | 3207 Rosemont Drive, Chattanooga, TN 37411 | 2010-10-18 |
| 1689803843 | Pauline Evans | Occupational Therapy Assistant | 1557 Pin Oak Dr, Chattanooga, TN 37411 | 2009-07-09 |
| Find all providers in zip 37411 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831645100 | Bobby Winbush | Residential Treatment Facility, Emotionally Disturbed Children | 1167 Parkland Rd, Memphis, TN 38111 | 2016-08-28 |
| 1043663495 | Tennessee Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 8550 Harold Duncan Way, Knoxville, TN 37931 | 2016-07-21 |
| 1447536875 | Children's Bureau Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 868 N Manassas St, Memphis, TN 38107-2516 | 2011-10-31 |
| 1588973309 | Lamont Ingram Developmental Organization | Residential Treatment Facility, Emotionally Disturbed Children | 437 Riverside Dr, Jackson, TN 38301-5720 | 2010-09-28 |
| 1073820130 | Tennessee Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 804 Branham Hughes Circle, Springhill, TN 37174-2623 | 2010-09-09 |
| 1629307046 | Arthur Lee Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 5425 Meadowick Ave, Memphis, TN 38115-3643 | 2009-12-14 |
| 1861687899 | The Agency for Youth and Family Development | Residential Treatment Facility, Emotionally Disturbed Children | 1071 Mullins Station Rd, Memphis, TN 38134-7723 | 2007-09-12 |
| 1427132786 | Parkwest Medical Center | Residential Treatment Facility, Emotionally Disturbed Children | 2341 Jones Bend Rd, Louisville, TN 37777 | 2006-10-24 |
| 1558916213 | Youth Villages, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 7410 Memphis Arlington Rd, Memphis, TN 38135-1908 | 2019-08-08 |
| 1922651348 | Youth Villages, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2890 Bekemeyer Dr, Arlington, TN 38002-9522 | 2019-07-24 |
| Find all providers with the same taxonomy | ||||
| City | CHATTANOOGA |
| Zip Code | 37411 |
Please comment or provide details below to improve the information on CASSANDRA WOODRUFF YOUTH CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.