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General NPI Number Information
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NPI Number | 1437295292
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Entity Type | Organization
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Legal Business Name | SERTOMA CENTER, INC.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 1400 E 5TH AVE
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City | KNOXVILLE
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State | TN
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Zip | 37917-7712
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Country | US
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Telephone | 865-524-5555
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Fax | 865-524-5563
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Provider Business Mailing Address
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Address Line | 1400 E 5TH AVE
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City | KNOXVILLE
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State | TN
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Zip | 37917-7712
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Country | US
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Telephone | 865-524-5555
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Fax | 865-524-5563
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. REBECCA D. MASSEY
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Credential |
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Telephone | 865-524-5555
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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 | L 3(20)4M6-056-1315
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License Number State | TN
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