Organization
FRONTIER HEALTH
Active
Other names
Independence House
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
2532 4TH AVE E, BIG STONE GAP, VA 24219-3600
(276) 523-4357
(276) 523-2527
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
315-02-011
VA
Other
Enumeration date
01/11/2007
Last updated
10/04/2018
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