MIRROR LAKE RECOVERY CENTER – NPI #1770615619
Substance Abuse Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Health Care Provider Taxonomy Code for Substance Abuse Rehabilitation Facility

MIRROR LAKE RECOVERY CENTER is a substance abuse rehabilitation facility located in BURNS, TN. NPPES has assigned the NPI number 1770615619 to MIRROR LAKE RECOVERY CENTER on March 09, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “MIRROR LAKE RECOVERY CENTER” is a dba name, the actual legal business name for this organization is CRC HEALTH TENNESSEE, LLC. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 324500000X from the Health Care Provider Taxonomy code set, which is classified as Substance Abuse Rehabilitation Facility.

The NPI profile was previously updated about 3 years ago on Aug 28, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MIRROR LAKE RECOVERY CENTER below.

NPI Profile for
CRC HEALTH TENNESSEE, LLC

NPI Number
1770615619
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CRC HEALTH TENNESSEE, LLC
Doing Business As (dba): MIRROR LAKE RECOVERY CENTER
Primary location
999 GIRL SCOUT RD
BURNS, TN 37029
Phone: (615) 446-7034 Fax: (615) 446-7061
Mailing address
6100 TOWER CIR STE 1000
FRANKLIN, TN 37067-1509
Phone: (615) 861-6000 Fax:
Organization Subpart
No
Authorized Official
BRIAN FARLEY
VP & SECRETARY
Phone: (615) 861-6000
Updated
Certification Date
Aug 28, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
324500000X
- Substance Abuse Rehabilitation Facility (Primary)		 TN 0000000116
261QR0401X
- Clinic/Center / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)		 TN 7378

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.