STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER NPI 1811159072

NPI Information

NPI: 1811159072
Provider Name: STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER

Doing Business As: GREENE VALLEY DEVELOPMENTAL CENTER

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
4850 E ANDREW JOHNSON HWY
GREENEVILLE, TN
ZIP 37745
Phone: (423) 787-6570
Get Directions

STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER is an intermediate care facility mentally retarded in Greeneville, TN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER NPI is 1811159072. The provider is registered as an organization entity type.
The provider Is Doing Business As Greene Valley Developmental Center.

The provider's business location address is:

4850 E ANDREW JOHNSON HWY
GREENEVILLE, TN
ZIP 37745-098
Phone: (423) 787-6570
Fax: (423) 787-6975

The provider's authorized official is Gary D Simcox .
The authorized official title is Fiscal Director 1 and has the following contact phone number (423) 787-6570.

The enumeration date for this NPI number is 6/30/2008 and was last updated on 6/30/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		L3231061620	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7447018	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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