FORTWOOD CENTER, INC. (NPI# 1912134057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912134057 |
| Entity Type | Organization |
| Organization Name | FORTWOOD CENTER, INC. |
| Other Organization Name | ROSEWOOD 2 |
| Practice Address |
1400 Bailey Ave Chattanooga TN 37404-2903 |
| Mailing Address |
1028 E 3rd St Chattanooga TN 37403-2107 |
| Practice Telephone | 4232666751 |
| Practice Fax Number | 4237634650 |
| Mailing Telephone | 4232666751 |
| Mailing Fax Number | 4237634650 |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2009-06-16 |
| Authorized Official Name | MRS. MELISSA QUEEN-PENNINGTON (CFO) |
| Authorized Official Telephone | 4232666751 |
| Is Organization Subpart | Y |
| Parent Organization Name | MENTAL HEALTH CENTERS & CLINICS OF FORTWOOD CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | L000000003969 | TN | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3399761 | 05 |
| Other Name | Type Code |
|---|---|
| Rosewood 2 | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881821056 | Fortwood Center, Inc. | Community/Behavioral Health | 1411 Bailey Ave, Chattanooga, TN 37404-2904 | 2009-06-16 |
| 1366679409 | Fortwood Center, Inc. | Community/Behavioral Health | 1508 Old Ringgold Rd, Chattanooga, TN 37404-5444 | 2009-06-16 |
| 1457588592 | Fortwood Center, Inc. | Community/Behavioral Health | 1510 Old Ringgold Rd, Chattanooga, TN 37404-5444 | 2009-06-16 |
| Street Address |
1400 BAILEY AVE |
| City | CHATTANOOGA |
| State | TN |
| Zip Code | 37404-2903 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902404825 | Bethany Joy Zufall | Behavior Technician | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2020-10-13 |
| 1881200905 | William Adkisson II | Behavior Technician | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2020-09-23 |
| 1245844943 | Jessica Lyon Faircloth | Behavior Technician | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2020-09-01 |
| 1134751985 | Manda Lea Kingsley | Social Worker | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2020-02-10 |
| 1598304677 | Diana Biciusca | Behavior Technician | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2020-01-06 |
| 1396381059 | Kevin Carter | Behavior Technician | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2019-11-18 |
| 1467008946 | Osha Thomas | Behavior Technician | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2019-08-12 |
| 1114480175 | Andrea Fuchs | Case Manager/Care Coordinator | 1400 Bailey Ave, Chattanooga, TN 37404-2903 | 2019-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306494216 | Cynthia Caffey | Technician | 1305 E. 28th St. Apt A, Chatta, TN 37404 | 2019-09-04 |
| 1851944482 | Stacey Stokes | Peer Specialist | 1413 Bailey Ave, Chattanooga, TN 37404 | 2019-07-23 |
| 1306354790 | Erlanger Behavioral Health, LLC | Psychiatric Hospital | 804 North Holtzclaw Avenue, Chattanooga, TN 37404 | 2018-01-19 |
| 1245746171 | Davis Supportive Living Home Inc. | Custodial Care Facility | 1106 Duncan Avenue, Chattanooga, TN 37404 | 2017-12-14 |
| 1124544762 | Rachael Anne Maciver | Nurse Practitioner | 1909 South Willow Street, Chattanooga, TN 37404 | 2017-08-15 |
| 1447796214 | Esli Castillo | Nurse Practitioner | 281 N.lyerly St., Suite 200, Chattanooga, TN 37404 | 2017-01-17 |
| 1922542158 | Natasha Elliott | Community Health Worker | 2804 Cannon Ave, Chattanooga, TN 37404 | 2016-12-07 |
| 1730630153 | Jonathan Easter | Taxi | 1611 Anderson Avenue, Apt A, Chattanooga, TN 37404 | 2016-10-20 |
| 1477946143 | Thomas Jereme Holcomb | Nurse Practitioner | 281 N. Lyerly St, Suite 200, Chattanooga, TN 37404 | 2015-03-05 |
| 1922426709 | Sarah Mccary Baker | Internal Medicine | 605 Glenwood Drive, Suite 300, Chattanooga Internal Medicine Group, Chattanooga, TN 37404 | 2014-03-31 |
| Find all providers in zip 37404 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932745817 | Sound Living Inc | Community/Behavioral Health | 6727 Heritage Business Court, Suite 720, Chattanooga, TN 37421 | 2019-11-26 |
| 1609398312 | Advanced Behavioral-emotional Care Services, LLC. | Community/Behavioral Health | 200 W Ml King Blvd Ste 1000, Chattanooga, TN 37402-2571 | 2017-07-13 |
| 1992184634 | Tyronda Wilkerson | Community/Behavioral Health | 621 Memorial Dr Apt 1903, Chattanooga, TN 37415-5528 | 2015-05-27 |
| 1316343650 | Caring Hands & Open Hearts, LLC | Community/Behavioral Health | 5751 Uptain Rd Ste 105, Chattanooga, TN 37411-5671 | 2014-11-14 |
| 1639420417 | Ctr. for Individual & Family Effectiveness | Community/Behavioral Health | 310 E. 8th St., Ste. C, Chattanooga, TN 37403 | 2012-09-20 |
| 1467708594 | Ctr. for Individ. & Family Effectiveness | Community/Behavioral Health | 2441 Broad St., Ste. 150, Chattanooga, TN 37408 | 2012-07-26 |
| 1609196799 | Hamilton County Health Dept | Community/Behavioral Health | 921 E Third St, Chattanooga, TN 37403 | 2010-06-11 |
| 1881821056 | Fortwood Center, Inc. | Community/Behavioral Health | 1411 Bailey Ave, Chattanooga, TN 37404-2904 | 2009-06-16 |
| 1366679409 | Fortwood Center, Inc. | Community/Behavioral Health | 1508 Old Ringgold Rd, Chattanooga, TN 37404-5444 | 2009-06-16 |
| 1457588592 | Fortwood Center, Inc. | Community/Behavioral Health | 1510 Old Ringgold Rd, Chattanooga, TN 37404-5444 | 2009-06-16 |
| Find all providers in CHATTANOOGA | ||||
| City | CHATTANOOGA |
| Zip Code | 37404 |
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| 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.