Provider Demographics
NPI:1073820130
Name:TENNESSEE CHILDREN'S HOME
Entity Type:Organization
Organization Name:TENNESSEE CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:931-486-2274
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-0010
Mailing Address - Country:US
Mailing Address - Phone:931-486-2274
Mailing Address - Fax:931-486-1231
Practice Address - Street 1:804 BRANHAM HUGHES CIRCLE
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2623
Practice Address - Country:US
Practice Address - Phone:931-486-2274
Practice Address - Fax:931-486-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000004997322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children