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Organization
TAKOMA REGIONAL HOSPITAL, INC
Active
Organization
TAKOMA REGIONAL HOSPITAL, INC
Active
Other names
GREENEVILLE COMMUNITY HOSPITAL PSYCHIATRIC
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
401 TAKOMA AVE, GREENEVILLE, TN 37743-4647
(423) 639-3151
(423) 636-2399
Mailing address
311 PRINCETON RD SUITE 1, JOHNSON CITY, TN 37601-2026
(423) 639-3151
(423) 639-2399
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
54
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100020449
PREFERRED HEALTH
TN
01
—
1000393
BLUE CROSS
TN
05
—
4400050
—
TN
01
—
A3774301
JOHN DEERE
TN
01
—
A3774401
AMERICHOICE
TN
Enumeration date
03/05/2007
Last updated
04/01/2019
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