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Organization
STATE OF TENNESSEE
Active
Organization
STATE OF TENNESSEE
Active
Other names
Department of Intellectual and Developmental Disabilities
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID COMM (DIRECTOR OF BUSINESS SERVICES)
(629) 267-8103
Entity
Organization
Contact information
Practice address
2105 SUSONG RD, GREENEVILLE, TN 37743-4944
(423) 787-0659
Mailing address
315 DEADERICK ST FL 8, NASHVILLE, TN 37238-3000
(615) 253-6713
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
315P00000X
Intellectual Disabilities Intermediate Care Facility
I000000010131
TN
Other
Enumeration date
01/26/2012
Last updated
07/05/2023
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