1316944887 NPI number — PRESBYTERIAN HOMES OF TENNESSEE, INC.

Table of content: (NPI 1316944887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316944887 NPI number — PRESBYTERIAN HOMES OF TENNESSEE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN HOMES OF TENNESSEE, INC.
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:
6
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:
1316944887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 VANOSDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909-2497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-690-3411
Provider Business Mailing Address Fax Number:
865-691-3099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 VANOSDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909-2497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-690-3411
Provider Business Practice Location Address Fax Number:
865-691-3099
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
TODD
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VP - ADMINISTRATOR
Authorized Official Telephone Number:
865-690-3411

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0000000150 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 1295 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4407967 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0445105 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7440166 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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