Organization · Type 2 NPI

Frontier Health

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Bristol, TN

NPI number 1073735643 Active

Practice location

719 Kentucky Ave
Bristol, TN 37620-3806

Call (423) 968-2532 Map

Mailing address

PO Box 9054
Gray, TN 37615-9054

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary	320900000X	L 324-076-1411 (TN)

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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NPI record

NPI: 1073735643
Entity type: Organization (Type 2)
Issued: May 3, 2007
Last updated: Jan 10, 2020
Status: Active

Other names

<unavail>
Fairmount Group Home · doing business as
Faimount Group Home · doing business as
Faimount Group Home · doing business as

Authorized official

Mrs. Kristie Hammonds
President and CEO
(423) 467-3600

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1073735643

Frontier Health's National Provider Identifier is 1073735643, issued on May 3, 2007. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Bristol, TN. The record was last updated on Jan 10, 2020.