Healthcare Provider Details

I. General information

NPI: 1518055367
Provider Name (Legal Business Name): ALLEGHANY HIGHLANDS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S MONROE AVE
COVINGTON VA
24426-1635
US

IV. Provider business mailing address

601 MAIN ST
CLIFTON FORGE VA
24422-1759
US

V. Phone/Fax

Practice location:
  • Phone: 540-965-2100
  • Fax:
Mailing address:
  • Phone: 540-863-1600
  • Fax: 540-863-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number12702001
License Number StateVA

VIII. Authorized Official

Name: PATTY FLANAGAN
Title or Position: FISCAL OFFICER
Credential:
Phone: 540-863-1600