Healthcare Provider Details

I. General information

NPI: 1386461101
Provider Name (Legal Business Name): MONICARE PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OLD VIRGINIA AVE
RICH CREEK VA
24147-9669
US

IV. Provider business mailing address

2640 TULIP LN
VINTON VA
24179-1530
US

V. Phone/Fax

Practice location:
  • Phone: 540-293-6669
  • Fax:
Mailing address:
  • Phone: 540-293-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA PANNELL
Title or Position: OWNER
Credential: PMHNP
Phone: 540-293-6669