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General NPI Number Information
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NPI Number | 1194886788
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Entity Type | Organization
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Legal Business Name | FRONTIER HEALTH
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 1100 US HIGHWAY 58
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City | DUFFIELD
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State | VA
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Zip | 24244
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Country | US
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Telephone | 276-431-4370
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Fax | 276-431-2863
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Provider Business Mailing Address
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Address Line | PO BOX 9054
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City | GRAY
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State | TN
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Zip | 37615-9054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. TERESA M KIDD
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Credential | PHD
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Telephone | 423-467-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 315-16-001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 315-07-004
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | 315-03-001
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 315-03-001
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License Number State | VA
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