NPIMap

Organization Active NPI

State of Tennessee

Doing business as Didd East TN Homes

  • Intellectual Disabilities Intermediate Care Facility
  • Afton, TN
National Provider Identifier
1467760876
Registry record updated Jun 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
STATE OF TENNESSEE
Doing business as
Didd East TN Homes
Practice address
855 Meadowbrook Rd
Afton, TN 37616-6047
Phone
(423) 787-6757
Fax
(423) 798-6253
NPI assigned
Sep 20, 2010
Last updated
Jun 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Margi Story
Title
East TN Homes Director
Phone
(423) 787-6757

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

855 Meadowbrook Rd
Afton, TN 37616-6047

Mailing address

190 Serral Dr
Greeneville, TN 37745-3074
Phone (423) 787-6757

Other identifiers 1

IdentifierTypeStateIssuer
7447148MedicaidTN

Other names 1

  • DIDD EAST TN HOMES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467760876. Details of each certification follow.

  • CCN 44G131 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G131

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
EAST TENNESSEE COMMUNITY HOMES MEADOWBROOK
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jan 5, 2011
Last certification
Aug 30, 2023
Beds
4
Ownership / control type
State
Facility address
855 Meadowbrook Road
Afton, TN 37616

National Provider Directory

National Provider Directory
Tax ID family
Maury Co Healt H Dept202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1467760876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 SERRAL DR",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377453074",
            "telephone_number": "423-787-6757",
            "fax_number": "423-798-6253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 MEADOWBROOK RD",
            "city": "AFTON",
            "state": "TN",
            "postal_code": "376166047",
            "telephone_number": "423-787-6757",
            "fax_number": "423-798-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "STORY",
        "authorized_official_first_name": "MARGI",
        "authorized_official_title_or_position": "EAST TN HOMES DIRECTOR",
        "authorized_official_telephone_number": "423-787-6757",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447148",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIDD EAST TN HOMES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Afton, TN

Sources for this page

Verify at the official NPI Registry.