Provider Demographics
NPI:1609854116
Name:EASTER SEALS TENNESSEE
Entity Type:Organization
Organization Name:EASTER SEALS TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-292-6640
Mailing Address - Street 1:750 OLD HICKORY BLVD # 2-260
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4528
Mailing Address - Country:US
Mailing Address - Phone:615-292-6640
Mailing Address - Fax:615-251-0994
Practice Address - Street 1:750 OLD HICKORY BLVD # 2-260
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4528
Practice Address - Country:US
Practice Address - Phone:615-292-6640
Practice Address - Fax:615-251-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X, 225XP0200X, 235Z00000X, 253Z00000X
TNL000000009654251C00000X
TNL000000009653251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2013709OtherAETNA PROVIDER #
TN4078521OtherBC/BS DME PROVIDER #
TN3131908OtherBC/BS PROVIDER #
TN323Medicaid
TN3131908OtherTENNCARE PROVIDER #
TN4078521OtherTENNCARE DME PROVIDER #
TN3131908OtherTENNCARE PROVIDER #