Healthcare Provider Details

I. General information

NPI: 1467674929
Provider Name (Legal Business Name): TAKOMA REGIONAL HOSPITAL DBA TAKOMA SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TAKOMA AVE
GREENEVILLE TN
37743-4647
US

IV. Provider business mailing address

401 TAKOMA AVE
GREENEVILLE TN
37743-4647
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-2446
  • Fax:
Mailing address:
  • Phone: 423-636-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BLIN RICHARDS
Title or Position: CFO
Credential:
Phone: 423-636-2376