| Supported Living - Kingsport | |
|
2017 Stonebrook Pl Kingsport TN 37660-4000 | |
| (423) 224-1417 | |
| (423) 224-1418 |
| Full Name | Supported Living - Kingsport |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2017 Stonebrook Pl, Kingsport, Tennessee |
| Authorized Official Name and Position | Teresa M Kidd (PRESIDENT AND CEO) |
| Authorized Official Contact | 4234673600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supported Living - Kingsport Po Box 9054 Gray TN 37615-9054 Ph: (423) 467-3600 | Supported Living - Kingsport 2017 Stonebrook Pl Kingsport TN 37660-4000 Ph: (423) 224-1417 |
| NPI Number | 1508917642 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 10/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508917642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | L 3(20)24M3-076-1414 (Tennessee) | Primary |
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