OrganizationActive
Frontier Health
NPI 1265597280 · Mental Illness Community Based Residential Treatment Facility · Kingsport, TN
Provider details
- NPI number
- 1265597280
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- E Varney, President and Ceo(423) 467-3600
- License
- L 219-076-1426 (TN)
Specialties & taxonomies
- Mental Illness Community Based Residential Treatment FacilityPrimary320800000XLicense L 219-076-1426 (TN)
Residential Treatment Facilities
Practice location
2221 Memorial Ct
Kingsport, TN 37664-3339
Phone: (423) 245-1121
Fax: (423) 467-3644
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 9054
Gray, TN 37615-9054
Other names (DBA / former)
- Doing business as
- Roller Russ Residence for Independent Living
Registry dates
- Enumerated
- 2006-12-27
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.