# NATCHEZ TRACE GROUP HOME, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124250733
- **Authorized official:** MR. VINCENT DE KONING (CEO)
- **Authorized official phone:** (931) 796-2039

## Contact information

- **Practice address:** 116 KITTRELL ST, HOHENWALD, TN 38462-1363
- **Practice address phone:** (931) 796-4400
- **Practice address fax:** (931) 796-4492
- **Mailing address:** PO BOX 309, HOHENWALD, TN 38462-0309
- **Mailing address phone:** (931) 796-2039
- **Mailing address fax:** (931) 796-5289

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | L000000003374 | TN | Yes |

## Other

- **Enumeration date:** 08/14/2009
- **Last updated:** 08/14/2009