Provider Demographics
NPI:1609924463
Name:FIRST TENNESSEE HUMAN RESOURCE AGENCY
Entity Type:Organization
Organization Name:FIRST TENNESSEE HUMAN RESOURCE AGENCY
Other - Org Name:NET TRANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:V
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-461-8209
Mailing Address - Street 1:704 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7264
Mailing Address - Country:US
Mailing Address - Phone:423-461-8238
Mailing Address - Fax:423-461-8228
Practice Address - Street 1:704 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7264
Practice Address - Country:US
Practice Address - Phone:423-461-8200
Practice Address - Fax:423-461-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
TN501(C)(3)343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440674Medicaid