Provider Demographics
NPI:1447731492
Name:KINGSPORT FAMILY RECOVERY ASSOCIATES
Entity type:Organization
Organization Name:KINGSPORT FAMILY RECOVERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-741-8415
Mailing Address - Street 1:PO BOX 2061
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-2061
Mailing Address - Country:US
Mailing Address - Phone:423-288-0223
Mailing Address - Fax:423-288-0220
Practice Address - Street 1:1729 LYNN GARDEN DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37665-1365
Practice Address - Country:US
Practice Address - Phone:423-288-0223
Practice Address - Fax:423-288-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000040883261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care