Provider Demographics
NPI:1093231722
Name:ENHANCED SUPPORT SERVICES
Entity Type:Organization
Organization Name:ENHANCED SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNER-POFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-631-0336
Mailing Address - Street 1:157 RUBY R CT
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4655
Mailing Address - Country:US
Mailing Address - Phone:423-631-0336
Mailing Address - Fax:423-631-0339
Practice Address - Street 1:2882 BOONES CREEK RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4655
Practice Address - Country:US
Practice Address - Phone:423-631-0336
Practice Address - Fax:423-631-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14965320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities