Organization
BURKEY ROAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY THOMAS (EXECUTIVE DIRECTOR)
(423) 638-3926
Entity
Organization
Contact information
Practice address
100 PENNSYLVANIA AVE, GREENEVILLE, TN 37743-4624
(423) 638-3926
(423) 638-1105
Mailing address
100 PENNSYLVANIA AVE, GREENEVILLE, TN 37743-4624
(423) 638-3926
(423) 638-1105
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
L000000015029
TN
315P00000X
Intellectual Disabilities Intermediate Care Facility
L000000016996
TN
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44-G144
PROVIDER #
TN
Enumeration date
08/27/2010
Last updated
11/20/2020
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