Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Russell County Psychiatric Unit
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
58 CARROLL ST, LEBANON, VA 24266-4510
(276) 883-8000
(276) 883-8250
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(276) 883-8000
(276) 883-8250
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
H1892
VA
Other
Enumeration date
01/31/2008
Last updated
03/29/2018
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