Organization
FRONTIER HEALTH
Active
Other names
Pierce House Residential Group Home
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
100 LAUREL RIDGE DR, BIG STONE GAP, VA 24219-2756
(276) 523-1536
(276) 523-1537
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
315-01-001
VA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
315-01-001
VA
Other
Enumeration date
01/16/2007
Last updated
10/05/2018
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