NPIMap

Organization Active NPI

State of TN

  • Intellectual Disabilities Intermediate Care Facility
  • Chuckey, TN
National Provider Identifier
1881980464
Registry record updated Jun 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
STATE OF TN
Practice address
590 Stone Dam Rd
Chuckey, TN 37641-4905
Phone
(423) 787-6757
Fax
(423) 798-6253
NPI assigned
Jun 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 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

590 Stone Dam Rd
Chuckey, TN 37641-4905

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7447162MedicaidTN

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

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G143

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 STONE DAM #3
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 21, 2011
Last certification
Aug 16, 2023
Beds
4
Ownership / control type
State
Facility address
590 Stone Dam Road
Chuckey, TN 37641

National Provider Directory

National Provider Directory
Tax ID family
Trousdale County Health202 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": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308700800000",
    "number": "1881980464",
    "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": "590 STONE DAM RD",
            "city": "CHUCKEY",
            "state": "TN",
            "postal_code": "376414905",
            "telephone_number": "423-787-6757",
            "fax_number": "423-798-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "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": "7447162",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIDD EAST TN HOMES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chuckey, TN

Sources for this page

Verify at the official NPI Registry.