NPIMap

Organization Active NPI

Orange Grove Center, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Chattanooga, TN
National Provider Identifier
1760696322
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
L3230961547 Issued in TN
Legal business name
ORANGE GROVE CENTER, INC.
Practice address
916A Glenwood Dr
Chattanooga, TN 37406-3328
Phone
(423) 629-1451
Fax
(423) 624-1294
NPI assigned
May 10, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X L3230961547 TN Primary

Addresses

Primary practice location

916A Glenwood Dr
Chattanooga, TN 37406-3328

Mailing address

615 Derby St
Chattanooga, TN 37404-1632
Phone (423) 629-1451

Other identifiers 1

IdentifierTypeStateIssuer
7447073MedicaidTN

National Provider Directory

National Provider Directory
Tax ID family
Health Habilitation SRV22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

615 Derby St
Chattanooga, TN 37404
Phone (423) 493-2905

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760696322",
    "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": "916A GLENWOOD DR",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374063328",
            "telephone_number": "423-629-1451",
            "fax_number": "423-624-1294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE GROVE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "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": "L3230961547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447073",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.