MEDICARE: NEW RIVER MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	MHL-003-005	NC

General Provider Information

NPI Number	:	1053377804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW RIVER MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	895 STATE FARM RD
Second Line	:	SUITE 508
City	:	BOONE
State	:	NC
Zip	:	28607-4917
Country	:	US
Telephone Number	:	828-264-9007
Fax Number	:	828-262-5687

Provider Business Practice Location Address
First Line	:	1650 HWY 18 SOUTH
Second Line	:
City	:	SPARTA
State	:	NC
Zip	:	28675-8478
Country	:	US
Telephone Number	:	336-372-4095
Fax Number	:	336-372-2722

Authorized Official
Title or Position	:	AREA DIRECTOR
Name	:	MR. DONALD L SUGGS
Credential	:	CEO
Telephone Number	:	828-264-9007

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	08/22/2020

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