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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