NPIMap

Organization Active NPI

State of Tennessee

Doing business as DIDD East TN Community Homes

  • Intellectual Disabilities Intermediate Care Facility
  • Greeneville, TN
National Provider Identifier
1629342415
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
I000000010288 Issued in TN
Legal business name
STATE OF TENNESSEE
Doing business as
DIDD East TN Community Homes
Practice address
102 Dyer St.
Greeneville, TN 37743
Phone
(423) 787-0879
Fax
(423) 787-6092
NPI assigned
Feb 27, 2012
Last updated
Feb 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Authorized official

Name
Mrs. Margi E Story
Title
Director
Phone
(423) 787-6757

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X I000000010288 TN Primary

Addresses

Primary practice location

102 Dyer St.
Greeneville, TN 37743

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
31500000XOtherTNTAXONOMY

Other names 1

  • DIDD East TN Community 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 1629342415. Details of each certification follow.

  • CCN 44G161 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G161

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 DYER STREET
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 31, 2012
Last certification
Jul 26, 2023
Beds
4
Ownership / control type
State
Facility address
102 Dyer Street
Greeneville, TN 37743

National Provider Directory

National Provider Directory
Tax ID family
Loudon County Health de202 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": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1629342415",
    "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": "423-787-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 DYER ST.",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "37743",
            "telephone_number": "423-787-0879",
            "fax_number": "423-787-6092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "STORY",
        "authorized_official_first_name": "MARGI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "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": "TN",
            "license": "I000000010288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "31500000X",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIDD East TN Community Homes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greeneville, TN

Sources for this page

Verify at the official NPI Registry.