OrganizationActive
Enhanced Support Services
NPI 1093231722 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Johnson City, TN
Provider details
- NPI number
- 1093231722
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Lisa Banner-Poff, Director(423) 631-0336
- License
- 14965 (TN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense 14965 (TN)
Residential Treatment Facilities
Profile Score
Established profile(69/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2882 Boones Creek Rd
Johnson City, TN 37615-4655
Phone: (423) 631-0336
Fax: (423) 631-0339
Street-level locationGet directions
Mailing address
157 Ruby R Ct
Jonesborough, TN 37659-4655
Registry dates
- Enumerated
- 2017-08-15
- Last updated
- 2017-08-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.