Provider Demographics
NPI:1861411985
Name:TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC
Entity type:Organization
Organization Name:TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-636-2376
Mailing Address - Street 1:401 TAKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4647
Mailing Address - Country:US
Mailing Address - Phone:423-639-3151
Mailing Address - Fax:423-636-2374
Practice Address - Street 1:401 TAKOMA AVE
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4647
Practice Address - Country:US
Practice Address - Phone:423-639-3151
Practice Address - Fax:423-636-2374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000054273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA3774401OtherJOHN DEERE HEALTH PLAN
TNA3774401OtherTC JOHN DEERE MCAID
TN100020449OtherTC PREF HEALTH PART MCAID
TN1000393OtherTC TENNCARE SELECT
TN1000393OtherTC BLUE CARE
TN1000393OtherBLUE CROSS
TNA3774301OtherMEDICARE MANAGED CARE
TN440050Medicaid
TNA3774401OtherJOHN DEERE HEALTH PLAN
TN1000393OtherTC TENNCARE SELECT
TN=========OtherTC PREMIER BEHAVIORAL SYS
TNA3774401OtherTC JOHN DEERE MCAID
TN440050Medicaid
TN=========OtherTC TENNESSEE BEHAVIORAL
TN=========004OtherTRICARE