Healthcare Provider Details

I. General information

NPI: 1609924463
Provider Name (Legal Business Name): FIRST TENNESSEE HUMAN RESOURCE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 ROLLING HILLS DR
JOHNSON CITY TN
37604-7264
US

IV. Provider business mailing address

704 ROLLING HILLS DR
JOHNSON CITY TN
37604-7264
US

V. Phone/Fax

Practice location:
  • Phone: 423-461-8200
  • Fax: 423-461-8228
Mailing address:
  • Phone: 423-461-8238
  • Fax: 423-461-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number501(C)(3)
License Number StateTN

VIII. Authorized Official

Name: JASON V CODY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 423-461-8209