Organization
ENHANCED SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BANNER-POFF (DIRECTOR)
(423) 631-0336
Entity
Organization
Contact information
Practice address
2882 BOONES CREEK RD, JOHNSON CITY, TN 37615-4655
(423) 631-0336
(423) 631-0339
Mailing address
157 RUBY R CT, JONESBOROUGH, TN 37659-4655
(423) 631-0336
(423) 631-0339
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
14965
TN
Other
Enumeration date
08/15/2017
Last updated
08/15/2017
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