Provider Demographics
NPI:1881613909
Name:TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC.
Entity type:Organization
Organization Name:TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-636-2376
Mailing Address - Street 1:401 TAKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4647
Mailing Address - Country:US
Mailing Address - Phone:423-639-3151
Mailing Address - Fax:423-636-2374
Practice Address - Street 1:401 TAKOMA AVE
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4647
Practice Address - Country:US
Practice Address - Phone:423-639-3151
Practice Address - Fax:423-636-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000054282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000393OtherTC TENNCARE SELECT
TN3278734OtherMEDICARE PART B GROUP #
TNA3774401OtherJOHN DEERE HEALTH PLAN
TN1000393OtherTC BLUE CARE
TNA3774301OtherMEDICARE MANAGED CARE
TNA3774401OtherTC JOHN DEERE MEDICAID
TN3924507OtherMEDICARE LCSW GROUP
TN440050Medicaid
TN1000393OtherBLUE CROSS
TN1000393OtherTC BLUE CARE
TN440050Medicaid
TNA3774301OtherMEDICARE MANAGED CARE
TNA3774401OtherJOHN DEERE HEALTH PLAN
TNA3774401OtherTC JOHN DEERE MEDICAID
TN=========OtherTC TENNESSEE BEHAVIORAL