Organization
FRONTIER HEALTH
Active
Parent organization
FRONTIER HEALTH
Other names
R. GRANT WIDNER GROUP HOME
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRONTIER HEALTH
Authorized official
MS. TERESA M KIDD PHD (PRESIDENT/CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
4121 OLD JONESBORO RD, BRISTOL, TN 37620-5342
(423) 652-7378
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
20647
TN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
L 324-076-1424
TN
323P00000X
Psychiatric Residential Treatment Facility
L324-076-1424
TN
Other
Enumeration date
05/03/2007
Last updated
10/05/2018
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