Organization · Type 2 NPI

State of Tennessee

Intellectual Disabilities Intermediate Care Facility · Greeneville, TN

NPI number 1629342415 Active

Practice location

102 Dyer St.
Greeneville, TN 37743

Call (423) 787-0879 Map

Fax (423) 787-6092

Mailing address

190 Serral Dr
Greeneville, TN 37745-3074

Specialties and licenses

TaxonomyCodeLicense
Intellectual Disabilities Intermediate Care Facility Primary 315P00000XI000000010288 (TN)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

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About NPI 1629342415

State of Tennessee's National Provider Identifier is 1629342415, issued on Feb 27, 2012. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Greeneville, TN. The record was last updated on Feb 27, 2012.