Healthcare Provider Details

I. General information

NPI: 1568827780
Provider Name (Legal Business Name): THREE RIVERS TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 HICKORY RD
KENBRIDGE VA
23944-3503
US

IV. Provider business mailing address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

V. Phone/Fax

Practice location:
  • Phone: 434-676-1378
  • Fax: 804-863-4626
Mailing address:
  • Phone: 804-861-0700
  • Fax: 804-863-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. ANTHONY J VADELLA
Title or Position: MANAGING MEMBER
Credential:
Phone: 804-861-0700