Healthcare Provider Details

I. General information

NPI: 1730228776
Provider Name (Legal Business Name): HOLSTON UNITED METHODIST HOME FOR CHILDREN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HOLSTON DR
GREENEVILLE TN
37743-3126
US

IV. Provider business mailing address

404 HOLSTON DR
GREENEVILLE TN
37743-3126
US

V. Phone/Fax

Practice location:
  • Phone: 423-638-4171
  • Fax:
Mailing address:
  • Phone: 423-638-4171
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBBIE J PRICE
Title or Position: ACCOUNTING ASSISTANT
Credential:
Phone: 423-638-4171