Provider Demographics
NPI:1306081427
Name:STATE OF TENNESSEE
Entity type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:C.
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMORRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MBA
Authorized Official - Phone:901-745-7357
Mailing Address - Street 1:11437 MILTON WILSON ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-0000
Mailing Address - Country:US
Mailing Address - Phone:901-745-7357
Mailing Address - Fax:901-745-7251
Practice Address - Street 1:11437 MILTON WILSON ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-0000
Practice Address - Country:US
Practice Address - Phone:901-745-7357
Practice Address - Fax:901-745-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities