Organization
FRONTIER HEALTH
Active
Other names
Church Street Pavilion
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIE HAMMONDS (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
616 E CHURCH ST, SUITE A, GREENEVILLE, TN 37745-5084
(423) 639-3213
(423) 639-4692
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
L-214-076-1407
TN
251S00000X
Community/Behavioral Health Agency
Primary
L214-076-1407
TN
261QM0850X
Adult Mental Health Clinic/Center
L-214-076-1407
TN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
369
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-4919-6
—
VA
05
—
SAME AS MEDICARE #S
—
TN
Enumeration date
12/14/2006
Last updated
01/10/2020
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