Provider Demographics
NPI:1225199888
Name:ORANGE GROVE CENTER INC
Entity Type:Organization
Organization Name:ORANGE GROVE CENTER INC
Other - Org Name:ORANGE GROVE CENTER THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-493-2910
Mailing Address - Street 1:615 DERBY ST
Mailing Address - Street 2:ATTENTION: HEALTH INFORMATICS & REIMBURSEMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1632
Mailing Address - Country:US
Mailing Address - Phone:423-493-2906
Mailing Address - Fax:423-493-2950
Practice Address - Street 1:615 DERBY ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1632
Practice Address - Country:US
Practice Address - Phone:423-629-1451
Practice Address - Fax:423-493-2950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE GROVE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000065225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531219Medicaid
TN446589Medicare Oscar/Certification