Provider Demographics
NPI:1114256039
Name:LITTLE TENNESSEE VALLEY EDUCATIONAL COOPERATIVE
Entity Type:Organization
Organization Name:LITTLE TENNESSEE VALLEY EDUCATIONAL COOPERATIVE
Other - Org Name:BIRTH-TO-THREE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:POTOCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:865-458-8900
Mailing Address - Street 1:1432 E LEE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-6440
Mailing Address - Country:US
Mailing Address - Phone:865-458-8900
Mailing Address - Fax:865-458-8626
Practice Address - Street 1:1432 E LEE HWY
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-6440
Practice Address - Country:US
Practice Address - Phone:865-458-8900
Practice Address - Fax:865-458-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521526Medicaid