| NPI | 1972124618 |
|---|---|
| Other Name | DIDD KATIE BECKETT WAIVER |
| Entity Type | Organization |
| Authorized Contact | ANDY KIDD Deputy Commissioner 615-253-6710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2020-05-05 |