Organization · Type 2 NPI

State of Tennessee Greene Valley Developmental Center

Intellectual Disabilities Intermediate Care Facility · Greeneville, TN

NPI number 1811159072 Active

Practice location

4850 E Andrew Johnson Hwy
Greeneville, TN 37745-3098

Call (423) 787-6570 Map

Fax (423) 787-6975

Mailing address

PO Box 910
Greeneville, TN 37744-0910

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	L3231061620 (TN)

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

50 other providers at this address

Other intellectual disabilities intermediate care facility providers in Greeneville

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NPI record

NPI: 1811159072
Entity type: Organization (Type 2)
Issued: Jun 30, 2008
Last updated: Jun 30, 2008
Status: Active
Subpart: Yes of State of Tennessee

Other names

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Greene Valley Developmental Center · doing business as

Authorized official

Mr. Gary D Simcox, CPA CGFM
Fiscal Director 1
(423) 787-6570

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1811159072

State of Tennessee Greene Valley Developmental Center's National Provider Identifier is 1811159072, issued on Jun 30, 2008. 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 Jun 30, 2008.