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Shadybrook
Intellectual Disabilities Intermediate Care Facility in Greeneville, Tennessee
NPI 1528221587

Shadybrook is a Intellectual Disabilities Intermediate Care Facility based in Greeneville, TN. Shadybrook practices in Greeneville, TN. The NPI Number for Shadybrook is 1528221587 and holds a License No. L000000015032 (Tennessee).

The current practice location address for Shadybrook is 100 Pennsylvania Ave, Greeneville, TN and can be reached out via phone at 423-638-3926 and via fax at 423-638-1105.

Location: 100 Pennsylvania Ave, Greeneville, TN, 37743-4624
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1528221587
Provider Name
Shadybrook
Credential
Provider Entity Type
Organization
Address
100 Pennsylvania Ave, Greeneville, TN, 37743-4624
Phone Number
423-638-3926
Fax Number
423-638-1105
Provider Enumeration Date
07/09/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
7447099 01 TN ICF-MR
institution
Provider Business Practice Location Address Details
Address
100 Pennsylvania Ave
City
Greeneville
State
Tennessee
Zip
37743-4624
Phone Number
423-638-3926
Fax Number
423-638-1105
person
Provider Business Mailing Address Details
Address
100 Pennsylvania Ave
City
Greeneville
State
Tennessee
Zip
37743-4624
Phone Number
423-638-3926
Fax Number
423-638-1105
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
L000000015032 (Tennessee)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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