Organization Name: | FRONTIER HEALTH |
NPI Number: | 1073735643 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | E DOUGLAS VARNEY (PRESIDENT AND CEO) |
Mailing Address: | 719 Kentucky Ave Bristol |
State: | TN US |
Postal Code: | 376203806 |
Phone Number: | 4239682532 |
Fax Number: | |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | L 324-076-1411 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |