State of TN

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

STATE OF TN

Doing business as

Dids East TN Homes

Practice address

143 Delzie Randolph Rd
Chuckey, TN 37641-6247

Phone

(423) 787-6757

Fax

(423) 798-6253

NPI assigned

Jun 9, 2011

Last updated

Jun 9, 2011By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• DIDS EAST TN HOMES Doing business as

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 1982999777. Details of each certification follow.

• CCN 44G135 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G135

Legal name

EAST TENNESSEE COMMUNITY HOMES HORSECREEK

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 21, 2011

Last certification

Jul 26, 2023

Beds

4

Ownership / control type

State

Facility address

143 Delzie Randolph Road
Chuckey, TN 37641

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1982999777",
    "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": "143 DELZIE RANDOLPH RD",
            "city": "CHUCKEY",
            "state": "TN",
            "postal_code": "376416247",
            "telephone_number": "423-787-6757",
            "fax_number": "423-798-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2011-06-09",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIDS EAST TN HOMES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Joseph Schreiner, M.D.
• Meredith Richardson Shrader, PA
• State of TN (Didd East TN Homes)
• State of TN (Didd East TN Homes)
• State of TN (Didd East TN Homes)

• Intellectual Disabilities Intermediate Care Facility in Chuckey, TN
• Providers in Chuckey, 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 Jun 9, 2011; 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.