NPIMap

Organization Active NPI

Frontier Health

  • Mental Illness Community Based Residential Treatment Facility
  • Bristol, TN
National Provider Identifier
1801018387
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
20647 Issued in TN
Legal business name
FRONTIER HEALTH
Practice address
4121 Old Jonesboro Rd
Bristol, TN 37620-5342
Phone
(423) 652-7378
NPI assigned
May 3, 2007
Organization subpart
Yes
Parent organization
FRONTIER HEALTHAs reported in NPPES

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
Ms. Teresa M Kidd, PHD
Title
President/Ceo
Phone
(423) 467-3600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 20647 TN Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X L 324-076-1424 TN
Psychiatric Residential Treatment Facility 323P00000X L324-076-1424 TN

Addresses

Primary practice location

4121 Old Jonesboro Rd
Bristol, TN 37620-5342

Mailing address

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

Other names 1

  • R. GRANT WIDNER GROUP HOME Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lee County Integrated Care62 organizations share this tax ID, including this one
Part of
Lee County Integrated Care

Organizations with this tax ID in the same state 23

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

View all 23

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1801018387",
    "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": "4121 OLD JONESBORO RD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376205342",
            "telephone_number": "423-652-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONTIER HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRONTIER HEALTH",
        "enumeration_date": "2007-05-03",
        "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/CEO",
        "authorized_official_telephone_number": "423-467-3600",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "TN",
            "license": "20647",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TN",
            "license": "L 324-076-1424",
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "TN",
            "license": "L324-076-1424",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "R. GRANT WIDNER GROUP HOME",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "R. GRANT WIDNER GROUP HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bristol, 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.