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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