Healthcare Provider Details

I. General information

NPI: 1417041484
Provider Name (Legal Business Name): ALLEGHANY HIGHLANDS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E HAWTHORNE ST
COVINGTON VA
24426-1620
US

IV. Provider business mailing address

205 E HAWTHORNE ST
COVINGTON VA
24426-1620
US

V. Phone/Fax

Practice location:
  • Phone: 540-965-2135
  • Fax: 540-965-6371
Mailing address:
  • Phone: 540-965-2135
  • Fax: 540-965-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number12716001
License Number StateVA

VIII. Authorized Official

Name: PATTY FLANAGAN
Title or Position: FISCAL OFFICER
Credential:
Phone: 540-965-2135