1225021348 NPI number — TENNESSEE STATE VETERANS HOME BOARD

Table of content: (NPI 1225021348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225021348 NPI number — TENNESSEE STATE VETERANS HOME BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE STATE VETERANS HOME BOARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225021348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 11328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-225-1816
Provider Business Mailing Address Fax Number:
615-898-1181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 COMPTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-895-8850
Provider Business Practice Location Address Fax Number:
615-895-5091
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
615-225-1816

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  265007629 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0445270 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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