Organization
COMMUNITY HEALTH OF EAST TENNESSEE, INC
Active
Other names
Developmental Center
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA DABNEY (CEO)
(423) 562-1705
Entity
Organization
Contact information
Practice address
470 STONE MILL RD, JACKSBORO, TN 37757-4007
(423) 562-1156
(423) 566-5106
Mailing address
PO BOX 209, JACKSBORO, TN 37757-0209
(423) 563-1037
(423) 566-5106
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
I000000009684
TN
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
I000000009684
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
380
—
TN
01
—
I000000009684
TENNESSEE DEPARTMENT OF MENTAL HEALTH
TN
01
—
PSS0000000260
TENNESSEE DEPARTMENT OF HEALTJ
TN
Enumeration date
11/10/2011
Last updated
08/27/2020
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