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General NPI Number Information
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NPI Number | 1225932668
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Entity Type | Organization
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Legal Business Name | OPHIR BOND ENTERPRISES DIVERSIFIED
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 4104 HIGHWAY 411
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City | MADISONVILLE
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State | TN
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Zip | 37354-1561
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Country | US
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Telephone | 865-315-3235
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CLOVER HL
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City | SWEETWATER
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State | TN
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Zip | 37874-1119
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Country | US
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Telephone | 865-315-3235
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KATHERYN KINGERY
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Credential | LADAC II
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Telephone | 406-300-2984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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