Healthcare Provider Details

I. General information

NPI: 1316005549
Provider Name (Legal Business Name): NEW RIVER SERVICE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SHADOWLINE DR
BOONE NC
28607-4950
US

IV. Provider business mailing address

895 STATE FARM RD SUITE 508
BOONE NC
28607-4917
US

V. Phone/Fax

Practice location:
  • Phone: 828-268-0220
  • Fax: 828-262-5687
Mailing address:
  • Phone: 828-264-9007
  • Fax: 828-262-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA P ANDREWS
Title or Position: CEO
Credential: LPC
Phone: 828-372-4095