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General NPI Number Information
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NPI Number | 1609913599
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY CENTER
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3030 LEE HWY
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City | ATHENS
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State | TN
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Zip | 37303-5062
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Country | US
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Telephone | 423-745-8902
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Fax | 423-745-8934
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Provider Business Mailing Address
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Address Line | PO BOX 793
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City | ATHENS
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State | TN
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Zip | 37371-0793
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Country | US
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Telephone | 423-745-8902
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Fax | 423-745-8934
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PAMELA WADE PERDUE
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Credential |
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Telephone | 423-745-8902
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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 | L3(20)M2-086-1505
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License Number State | TN
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Legacy Identifiers
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Identifier #1
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Identifier Code | 00106
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Identifier Type | OTHER
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Identifier State | TN
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Identifier Issuer | DMRS PROVIDER NUMBER
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 00106
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Identifier Type | OTHER
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Identifier State | TN
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Identifier Issuer | DMRS PROVIDER NUMBER
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