Healthcare Provider Details

I. General information

NPI: 1386043594
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 MUSTANG LN
MIDDLETOWN VA
22645-1722
US

IV. Provider business mailing address

2609 MCVITTY RD
ROANOKE VA
24018-3513
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-2782
  • Fax: 540-450-2783
Mailing address:
  • Phone: 540-562-8473
  • Fax: 540-774-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number272-02-029
License Number StateVA

VIII. Authorized Official

Name: MS. FREIDA M. KING
Title or Position: CONTROLLER
Credential: BS
Phone: 540-562-8473