Provider Demographics
NPI:1932331899
Name:SMOKY MOUNTAIN CHILDREN'S HOME
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-453-4644
Mailing Address - Street 1:449 MCCARN CIR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-4176
Mailing Address - Country:US
Mailing Address - Phone:865-453-4644
Mailing Address - Fax:865-453-8812
Practice Address - Street 1:449 MCCARN CIR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4176
Practice Address - Country:US
Practice Address - Phone:865-453-4644
Practice Address - Fax:865-453-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSO/10502A251B00000X
TNSO/10501A253J00000X
TN1000000003835322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency