NPI 1093231722

Enhanced Support Services

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Johnson City, TN

Practice location

Address: 2882 Boones Creek Rd, Johnson City, TN 37615-4655
Phone: (423) 631-0336
Fax: (423) 631-0339
Mailing address: 157 Ruby R CT, Jonesborough, TN 37659-4655

Authorised official

Name: Lisa Banner-Poff
Title: Director
Phone: (423) 631-0336

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 14965 (TN)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Tennessee →

Registry record

NPI: 1093231722
Entity type: Organization
NPI issued: 15 Aug 2017
Record last updated: 15 Aug 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.