NPIMap

Organization Active NPI

State of Tennessee Greene Valley Developmental Center

Doing business as Greene Valley Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Greeneville, TN
National Provider Identifier
1811159072
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
L3231061620 Issued in TN
Legal business name
STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER
Doing business as
Greene Valley Developmental Center
Practice address
4850 E Andrew Johnson Hwy
Greeneville, TN 37745-3098
Phone
(423) 787-6570
Fax
(423) 787-6975
NPI assigned
Jun 30, 2008
Organization subpart
Yes
Parent organization
STATE OF TENNESSEEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

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

Authorized official

Name
Mr. Gary D Simcox, CPA CGFM
Title
Fiscal Director 1
Phone
(423) 787-6570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X L3231061620 TN Primary

Addresses

Primary practice location

4850 E Andrew Johnson Hwy
Greeneville, TN 37745-3098

Mailing address

PO Box 910
Greeneville, TN 37744-0910
Phone (423) 787-6570

Other identifiers 1

IdentifierTypeStateIssuer
7447018MedicaidTN

Other names 1

  • Greene Valley Developmental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Trousdale County Health202 organizations share this tax ID, including this one
Part of
Trousdale County Health

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": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1811159072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377440910",
            "telephone_number": "423-787-6570",
            "fax_number": "423-787-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 E ANDREW JOHNSON HWY",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377453098",
            "telephone_number": "423-787-6570",
            "fax_number": "423-787-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE GREENE VALLEY DEVELOPMENTAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF TENNESSEE",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "SIMCOX",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "FISCAL DIRECTOR 1",
        "authorized_official_telephone_number": "423-787-6570",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA CGFM"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L3231061620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447018",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greene Valley Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greeneville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.