# ENHANCED SUPPORT SERVICES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093231722
- **Authorized official:** LISA BANNER-POFF (DIRECTOR)
- **Authorized official phone:** (423) 631-0336

## Contact information

- **Practice address:** 2882 BOONES CREEK RD, JOHNSON CITY, TN 37615-4655
- **Practice address phone:** (423) 631-0336
- **Practice address fax:** (423) 631-0339
- **Mailing address:** 157 RUBY R CT, JONESBOROUGH, TN 37659-4655
- **Mailing address phone:** (423) 631-0336
- **Mailing address fax:** (423) 631-0339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 14965 | TN | Yes |

## Other

- **Enumeration date:** 08/15/2017
- **Last updated:** 08/15/2017