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General NPI Number Information
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NPI Number | 1962564435
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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 | 12/14/2006
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 426 E G ST
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City | ELIZABETHTON
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State | TN
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Zip | 37643-3224
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Country | US
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Telephone | 423-547-5950
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Fax | 423-547-5953
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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 | 423-467-3600
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Fax | 423-467-3644
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MRS. KRISTIE HAMMONDS
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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 | L-214-076-1406
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | L-214-076-1406
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License Number State | TN
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Taxonomy #3
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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 | 363
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | L-214-076-1406
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License Number State | TN
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