Provider Demographics
NPI:1962435255
Name:TAKOMA ADVENTIST HOSPITAL
Entity type:Organization
Organization Name:TAKOMA ADVENTIST HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-639-3151
Mailing Address - Street 1:1021 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4672
Mailing Address - Country:US
Mailing Address - Phone:423-636-0700
Mailing Address - Fax:423-636-0706
Practice Address - Street 1:1021 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4672
Practice Address - Country:US
Practice Address - Phone:423-636-0700
Practice Address - Fax:423-636-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000-86251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447417OtherCARITEN SENIOR HLTH MCR
TN447417OtherJOHN DEERE HLTH MCR
TN447417OtherUNITED HEALTHCARE
TN153116OtherTENNCARE SELECT
TN447417OtherSTERLING LIFE MCR
TN0007714697OtherAETNA
TN447417OtherJOHN DEER TENNCARE
TN0153116OtherBLUE CARE/BLUE SHIELD
TN447417OtherHUMANA INS GOLD CHC MCR
TN447417OtherPHP COMPANIES
TN447417OtherHUMANA INS GOLD CHC MCR