Provider Demographics
NPI:1699813907
Name:WASHINGTON COUNTY COMMUNITY RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY COMMUNITY RESIDENTIAL SERVICES, INC.
Other - Org Name:CORE SERVICES OF NORTHEAST TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-552-4835
Mailing Address - Street 1:215 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7339
Mailing Address - Country:US
Mailing Address - Phone:239-282-7524
Mailing Address - Fax:423-928-3680
Practice Address - Street 1:215 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7339
Practice Address - Country:US
Practice Address - Phone:239-282-7524
Practice Address - Fax:423-928-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3324M60861502251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services