Organization
NATCHEZ TRACE GROUP HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT DE KONING (CEO)
(931) 796-2039
Entity
Organization
Contact information
Practice address
116 KITTRELL ST, HOHENWALD, TN 38462-1363
(931) 796-4400
(931) 796-4492
Mailing address
PO BOX 309, HOHENWALD, TN 38462-0309
(931) 796-2039
(931) 796-5289
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
L000000003374
TN
Other
Enumeration date
08/14/2009
Last updated
08/14/2009
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