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General NPI Number Information
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NPI Number | 1306119599
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 275 STEWARTS FERRY PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3325
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Country | US
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Telephone | 615-231-5425
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Fax | 615-884-4405
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Provider Business Mailing Address
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Address Line | 275 STEWARTS FERRY PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3325
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Country | US
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Telephone | 615-231-5425
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Fax | 615-884-4405
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Authorized Official
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Title or Position | COTA/L
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Name | MRS. NICOLE LYNN JONES
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Credential |
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Telephone | 615-231-5425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 0000001013
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License Number State | TN
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