MEDICARE: NEW RIVER SERVICE AUTHORITY

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053512376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW RIVER SERVICE AUTHORITY

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	:	351 RIVERSIDE DR
Second Line	:	SUITE 100
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-3878
Country	:	US
Telephone Number	:	336-783-0357
Fax Number	:	828-262-5687

Authorized Official
Title or Position	:	CEO
Name	:	MS. PATRICIA P ANDREWS
Credential	:	MA, LPC
Telephone Number	:	828-264-9007

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	10/18/2007

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Directions to “NEW RIVER SERVICE AUTHORITY ” Practice Location

Language	Start Address	Practice Location

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