Organization
PINK COYOTE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES THOMAS CAMPBELL (PRESIDENT)
(865) 748-7002
Entity
Organization
Contact information
Practice address
117 COON HUNTERS RD, WARTBURG, TN 37887-3607
(865) 748-7003
(423) 346-1102
Mailing address
PO BOX 1057, WARTBURG, TN 37887-1057
(865) 748-7003
(423) 346-1102
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/14/2011
Last updated
11/14/2011
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