Healthcare Provider Details

I. General information

NPI: 1962984328
Provider Name (Legal Business Name): BOX ELDER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 RAINBOW RIDGE
BUMPASS VA
23024-4856
US

IV. Provider business mailing address

254 RAINBOW RIDGE
BUMPASS VA
23024-4856
US

V. Phone/Fax

Practice location:
  • Phone: 757-274-7527
  • Fax:
Mailing address:
  • Phone: 757-274-7527
  • Fax: 757-530-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTHA MAURNO
Title or Position: OWNER, BUSINESS MANAGER
Credential: M.S.
Phone: 757-274-7527