Organization
FRONTIER HEALTH
Active
Other names
Roller Russ Residence for Independent Living
Organization subpart
No
Provider details
NPI number
Authorized official
MR. E DOUGLAS VARNEY (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
2221 MEMORIAL CT, KINGSPORT, TN 37664-3339
(423) 245-1121
(423) 467-3644
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
L 219-076-1426
TN
Other
Enumeration date
12/27/2006
Last updated
08/22/2020
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