Organization
STATE OF TENNESSEE
Active
Other names
DIDD East TN Community Homes
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARGI E STORY (DIRECTOR)
(423) 787-6757
Entity
Organization
Contact information
Practice address
2497 BUCKINGHAM RD., GREENEVILLE, TN 37743
(423) 787-0824
(423) 787-6092
Mailing address
190 SERRAL DR, GREENEVILLE, TN 37745-3074
(423) 787-6757
(423) 787-6092
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
I000000010290
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31500000X
TAXONOMY
TN
Enumeration date
02/28/2012
Last updated
02/28/2012
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