Organization
FRONTIER HEALTH
Active
Other names
Developmental Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
622 POWELL AVE E, BIG STONE GAP, VA 24219-2348
(276) 523-0682
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
315-16-001
VA
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
315-02-006
VA
385H00000X
Respite Care
315-03-001
VA
Other
Enumeration date
02/20/2007
Last updated
10/05/2018
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