Provider Demographics
NPI:1578840138
Name:COMMUNITY HEALTH OF EAST TENNESSEE, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF EAST TENNESSEE, INC
Other - Org Name:DEVELOPMENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-562-1705
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-0209
Mailing Address - Country:US
Mailing Address - Phone:423-563-1037
Mailing Address - Fax:423-566-5106
Practice Address - Street 1:470 STONE MILL RD
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4007
Practice Address - Country:US
Practice Address - Phone:423-562-1156
Practice Address - Fax:423-566-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000009684251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN380Medicaid
TNPSS0000000260OtherTENNESSEE DEPARTMENT OF HEALTJ
TNI000000009684OtherTENNESSEE DEPARTMENT OF MENTAL HEALTH