Provider Demographics
NPI:1598986382
Name:TAKOMA REGIONAL HOSPITAL DBA TAKOMA OUTPATIENT BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:TAKOMA REGIONAL HOSPITAL DBA TAKOMA OUTPATIENT BEHAVIORAL SERVICES
Other - Org Name:TAKOMA OUTPATIENT BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-636-2376
Mailing Address - Street 1:303 TAKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4629
Mailing Address - Country:US
Mailing Address - Phone:423-636-0491
Mailing Address - Fax:
Practice Address - Street 1:303 TAKOMA AVE
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4629
Practice Address - Country:US
Practice Address - Phone:423-636-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty