Healthcare Provider Details

I. General information

NPI: 1609949007
Provider Name (Legal Business Name): GREENE VALLEY DEVELOPMENTAL CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E ANDREW JOHNSON HWY
GREENEVILLE TN
37745-3098
US

IV. Provider business mailing address

PO BOX 910
GREENEVILLE TN
37744-0910
US

V. Phone/Fax

Practice location:
  • Phone: 423-378-7665
  • Fax: 423-787-6776
Mailing address:
  • Phone: 423-378-7665
  • Fax: 423-787-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number711
License Number StateTN

VIII. Authorized Official

Name: HENRY CROCKETT MEECE
Title or Position: CHIEF OFFICER
Credential: PHD
Phone: 423-787-6568