Organization
FRONTIER HEALTH
Active
Other names
Supported Living - Kingsport
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
2017 STONEBROOK PL, KINGSPORT, TN 37660-4000
(423) 224-1417
(423) 224-1418
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
L 3(20)24M3-076-1414
TN
Other
Enumeration date
01/16/2007
Last updated
10/05/2018
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