Organization
FRONTIER HEALTH
Active
Organization
FRONTIER HEALTH
Active
Parent organization
FRONTIER HEALTH
Other names
HOLSTON RESIDENCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRONTIER HEALTH
Authorized official
MR. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
1800 MOUNTAIN VIEW AVE, KINGSPORT, TN 37664-3548
(423) 247-6340
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
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
L 324-076-1419
TN
Other
Enumeration date
05/03/2007
Last updated
09/24/2018
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