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Organization Active NPI

Frontier Health

Doing business as Supported Living - Kingsport

  • Community/Behavioral Health Agency
  • Kingsport, TN
National Provider Identifier
1508917642
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
L 3(20)24M3-076-1414 Issued in TN
Legal business name
FRONTIER HEALTH
Doing business as
Supported Living - Kingsport
Practice address
2017 Stonebrook PL
Kingsport, TN 37660-4000
Phone
(423) 224-1417
Fax
(423) 224-1418
NPI assigned
Jan 16, 2007
Last updated
Oct 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Teresa M Kidd, PHDNPI 1386656403
Title
President and Ceo
Phone
(423) 467-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X L 3(20)24M3-076-1414 TN Primary

Addresses

Primary practice location

2017 Stonebrook PL
Kingsport, TN 37660-4000

Mailing address

PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600

Other names 1

  • Supported Living - Kingsport Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wise County Integrated Care62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

  • Frontier Health

    dba Gibson Place 210

    • Psychiatric Residential Treatment Facility
    • Johnson City, TN
    • NPI 1124463849
    NPD tax ID
  • Frontier Health

    dba Fairview Associates of Johnson City

    • Community/Behavioral Health Agency
    • Johnson City, TN
    • NPI 1134282551
    NPD tax ID
  • Frontier Health
    • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
    • Kingsport, TN
    • NPI 1144460817
    NPD tax ID
  • Frontier Health

    dba Crisis Triage

    • Community/Behavioral Health Agency
    • Johnson City, TN
    • NPI 1174005276
    NPD tax ID
  • Frontier Health

    dba Bristol Regional Counseling Center

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Bristol, TN
    • NPI 1235291295
    NPD tax ID
  • Frontier Health

    dba Adventure Program

    • Adolescent and Children Mental Health Clinic/Center
    • Johnson City, TN
    • NPI 1235298720
    NPD tax ID
  • Frontier Health

    dba Roller Russ Residence for Independent Living

    • Mental Illness Community Based Residential Treatment Facility
    • Kingsport, TN
    • NPI 1265597280
    NPD tax ID
  • Frontier Health

    dba Laurel House

    • Mental Illness Community Based Residential Treatment Facility
    • Johnson City, TN
    • NPI 1265632392
    NPD tax ID
  • Frontier Health
    • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
    • Bristol, TN
    • NPI 1326288093
    NPD tax ID
  • Frontier Health

    dba Watauga Behavioral Health Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Johnson City, TN
    • NPI 1386700383
    NPD tax ID
  • Frontier Health

    dba Johnson County Counseling Center

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Mountain City, TN
    • NPI 1396809851
    NPD tax ID
  • Frontier Health
    • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
    • Johnson City, TN
    • NPI 1417197153
    NPD tax ID
View all 24

Locations

2017 E Stonebrook Pl
Kingsport, TN 37660
Phone (423) 224-1412

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1508917642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 STONEBROOK PL",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604000",
            "telephone_number": "423-224-1417",
            "fax_number": "423-224-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONTIER HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "423-467-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TN",
            "license": "L 3(20)24M3-076-1414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supported Living - Kingsport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Supported Living - Kingsport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.