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
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
I000000010131
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7447172
—
TN
Enumeration date
01/26/2012
Last updated
07/05/2023
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