# TAKOMA REGIONAL HOSPITAL

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

## Provider details

- **NPI number:** 1154450344
- **Authorized official:** MR. BLIN RICHARDS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (423) 636-0369

## Contact information

- **Practice address:** 401 TAKOMA AVE, GREENEVILLE, TN 37743-4647
- **Practice address phone:** (828) 687-5281
- **Practice address fax:** (828) 687-5298
- **Mailing address:** PO BOX 11407, BIRMINGHAM, AL 35246-1412
- **Mailing address phone:** (828) 687-5281
- **Mailing address fax:** (828) 687-5298

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 98 | TN | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0440050 | — | TN |
| 01 | — | 1000393 | BLUE CROSS | TN |
| 01 | — | A3774301 | JOHN DEERE | TN |
| 01 | — | A3774401 | AMERICHOICE | TN |