Provider Demographics
NPI:1780014514
Name:TULIP GROVE ROAD #1
Entity Type:Organization
Organization Name:TULIP GROVE ROAD #1
Other - Org Name:MIDDLE TENNESSEE HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-231-5373
Mailing Address - Street 1:275 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3325
Mailing Address - Country:US
Mailing Address - Phone:615-231-5000
Mailing Address - Fax:615-231-5074
Practice Address - Street 1:869 TULIP GROVE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37076
Practice Address - Country:US
Practice Address - Phone:615-231-5000
Practice Address - Fax:615-231-5074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLOVER BOTTOM DEVELOPMENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL00000001184315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities