Healthcare Provider Details

I. General information

NPI: 1245041094
Provider Name (Legal Business Name): CARILION HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 STEELES FORT RD STE 3
RAPHINE VA
24472-2550
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 877-544-3770
  • Fax: 540-857-5306
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GRISETTI
Title or Position: DIRECTOR OF OPERATIONAL SUPPORT
Credential:
Phone: 540-224-5352