Organization
STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER
Active
Parent organization
STATE OF TENNESSEE
Other names
Greene Valley Developmental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF TENNESSEE
Authorized official
MR. GARY D SIMCOX CPA CGFM (FISCAL DIRECTOR 1)
(423) 787-6570
Entity
Organization
Contact information
Practice address
4850 E ANDREW JOHNSON HWY, GREENEVILLE, TN 37745-3098
(423) 787-6570
(423) 787-6975
Mailing address
PO BOX 910, GREENEVILLE, TN 37744-0910
(423) 787-6570
(423) 787-6975
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
L3231061620
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7447018
—
TN
Enumeration date
06/30/2008
Last updated
06/30/2008
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