Orange Grove Center, Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

3230961537 Issued in TN

Legal business name

ORANGE GROVE CENTER, INC

Practice address

4403 Comet TRL
Hixson, TN 37343-4313

Phone

(423) 629-1451

Fax

(423) 624-1294

NPI assigned

May 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kyle Hauth

Title

Executive Director

Phone

(423) 629-1451

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G096

Legal name

ORANGE GROVE CENTER COMET TRAIL

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Feb 1, 1996

Last certification

Jul 9, 2025

Beds

4

Ownership / control type

Private (non-profit)

Facility address

4403 Comet Trail
Hixson, TN 37343

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629287073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 DERBY ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041632",
            "telephone_number": "423-629-1451",
            "fax_number": "423-624-1294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 COMET TRL",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434313",
            "telephone_number": "423-629-1451",
            "fax_number": "423-624-1294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE GROVE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAUTH",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "423-629-1451",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "3230961537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447113",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Ooten, PT
• Orange Grove Center, Inc
• Orange Grove Center, Inc
• Orange Grove Center, Inc
• Orange Grove Center, Inc
• Kelly M Ovante
• Dan Eugene Owen, O.D.
• Maria Lissette Pacheco, DPM
• Carolyn Blair Padalino, DPT
• Pamela H. Johnson, LCSW, PC

• Intellectual Disabilities Intermediate Care Facility in Hixson, TN
• Providers in Hixson, TN by specialty
• Intellectual Disabilities Intermediate Care Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.