Provider Demographics
NPI:1679040075
Name:CRESTPOINT PSYCHIATRIC CARE, LLC
Entity type:Organization
Organization Name:CRESTPOINT PSYCHIATRIC CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AIMUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-631-0024
Mailing Address - Street 1:PO BOX 4358
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4358
Mailing Address - Country:US
Mailing Address - Phone:423-913-4188
Mailing Address - Fax:
Practice Address - Street 1:206 PRINCETON RD STE 18
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2025
Practice Address - Country:US
Practice Address - Phone:423-631-0024
Practice Address - Fax:423-631-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty