Healthcare Provider Details

I. General information

NPI: 1235280892
Provider Name (Legal Business Name): FRONTIER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 BOONE TRAIL RD
DUFFIELD VA
24244
US

IV. Provider business mailing address

PO BOX 9054
GRAY TN
37615-9054
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-4473
  • Fax: 276-431-4484
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number315-02-006
License Number StateVA

VIII. Authorized Official

Name: MRS. TERESA M KIDD
Title or Position: PRESIDENT AND CEO
Credential: PHD
Phone: 423-467-3600