Provider Demographics
NPI:1417197153
Name:FRONTIER HEALTH
Entity Type:Organization
Organization Name:FRONTIER HEALTH
Other - Org Name:SPRING HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:E.
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-467-3600
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:1113 KING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5009
Practice Address - Country:US
Practice Address - Phone:423-928-4802
Practice Address - Fax:423-467-3644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONTIER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000002500320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities