Healthcare Provider Details

I. General information

NPI: 1982713152
Provider Name (Legal Business Name): NEW ROADS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12112 DRIFFIELD DRIVE
COEBURN VA
24230
US

IV. Provider business mailing address

PO BOX 1157
COEBURN VA
24230-1157
US

V. Phone/Fax

Practice location:
  • Phone: 276-395-3925
  • Fax: 276-395-5003
Mailing address:
  • Phone: 276-395-3925
  • Fax: 276-395-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number45101001
License Number StateVA

VIII. Authorized Official

Name: DIANE COLLINS
Title or Position: VICE PRESIDENT - ADMINISTRATOR
Credential:
Phone: 276-395-3925