Healthcare Provider Details

I. General information

NPI: 1962435255
Provider Name (Legal Business Name): TAKOMA ADVENTIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COOLIDGE ST
GREENEVILLE TN
37743-4672
US

IV. Provider business mailing address

1021 COOLIDGE ST
GREENEVILLE TN
37743-4672
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-0700
  • Fax: 423-636-0706
Mailing address:
  • Phone: 423-636-0700
  • Fax: 423-636-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number00000000-86
License Number StateTN

VIII. Authorized Official

Name: BLIN RICHARDS
Title or Position: CFO
Credential:
Phone: 423-639-3151