Provider Demographics
NPI:1770576654
Name:COMPREHENSIVE COMMUNITY SERVICES
Entity type:Organization
Organization Name:COMPREHENSIVE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-928-6581
Mailing Address - Street 1:321 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6774
Mailing Address - Country:US
Mailing Address - Phone:423-928-6581
Mailing Address - Fax:423-928-6215
Practice Address - Street 1:6145 TEMPLE STAR RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-8028
Practice Address - Country:US
Practice Address - Phone:423-928-6581
Practice Address - Fax:423-928-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000101324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility