Healthcare Provider Details

I. General information

NPI: 1023499639
Provider Name (Legal Business Name): STATE OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 DENNYWOOD DRIVE
DONELSON TN
37214
US

IV. Provider business mailing address

315 DEADERICK ST FL 8
NASHVILLE TN
37238-3000
US

V. Phone/Fax

Practice location:
  • Phone: 615-231-5373
  • Fax: 615-231-5074
Mailing address:
  • Phone:
  • Fax: 615-253-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID COMM
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 629-267-8103