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General NPI Number Information
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NPI Number | 1609949007
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Entity Type | Organization
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Legal Business Name | GREENE VALLEY DEVELOPMENTAL CENTER PHARMACY
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 4850 E ANDREW JOHNSON HWY
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City | GREENEVILLE
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State | TN
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Zip | 37745-3098
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Country | US
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Telephone | 423-378-7665
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Fax | 423-787-6776
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Provider Business Mailing Address
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Address Line | PO BOX 910
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City | GREENEVILLE
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State | TN
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Zip | 37744-0910
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Country | US
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Telephone | 423-378-7665
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Fax | 423-787-6776
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | HENRY CROCKETT MEECE
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Credential | PHD
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Telephone | 423-787-6568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 711
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License Number State | TN
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