Provider Demographics
NPI:1821126475
Name:TAKOMA REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:TAKOMA REGIONAL HOSPITAL INC
Other - Org Name:TAKOMA REGIONAL HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-636-0369
Mailing Address - Street 1:1012 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4610
Mailing Address - Country:US
Mailing Address - Phone:828-687-5281
Mailing Address - Fax:828-687-5298
Practice Address - Street 1:1012 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4610
Practice Address - Country:US
Practice Address - Phone:828-687-5281
Practice Address - Fax:828-687-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447417Medicare ID - Type Unspecified
TN447417Medicare Oscar/Certification