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

## Provider details

- **NPI number:** 1396133096
- **Authorized official:** MR. JEFFREY MCKEE (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (423) 612-8628

## Contact information

- **Practice address:** 305 SPEARHEAD CIR, KINGSPORT, TN 37664-6200
- **Practice address phone:** (423) 323-5092
- **Practice address fax:** (423) 323-5092
- **Mailing address:** 305 SPEARHEAD CIR, KINGSPORT, TN 37664-6200
- **Mailing address phone:** (423) 323-5092
- **Mailing address fax:** (423) 323-5092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/03/2015
- **Last updated:** 01/03/2015