Organization
ORANGE GROVE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE HAUTH (EXECUTIVE DIRECTOR)
(423) 629-1451
Entity
Organization
Contact information
Practice address
916B GLENWOOD DR, CHATTANOOGA, TN 37406-3328
(423) 629-1451
(423) 624-1294
Mailing address
615 DERBY ST, CHATTANOOGA, TN 37404-1632
(423) 629-1451
(423) 624-1294
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
3230961548
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7447074
—
TN
Enumeration date
05/23/2007
Last updated
08/22/2020
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