1790726503 NPI number — TENNESSEE STATE VETERANS HOME BOARD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790726503 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:
1790726503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO 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:
ONE VETERANS WAY
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:
37931-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-862-8100
Provider Business Practice Location Address Fax Number:
865-690-5981
Provider Enumeration Date:
06/10/2006

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0445484 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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