Organization
FRONTIER HEALTH
Active
Other names
Independence Unlimited
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
4907 BOONE TRAIL RD, DUFFIELD, VA 24244
(276) 431-4473
(276) 431-4484
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
315-02-006
VA
Other
Enumeration date
01/12/2007
Last updated
10/04/2018
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