Healthcare Provider Details

I. General information

NPI: 1982544748
Provider Name (Legal Business Name): COMMUNITY ARTSREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 FRONTIER ROAD NW
ROANOKE VA
24012
US

IV. Provider business mailing address

217 RUTHERFORD CT NW
ROANOKE VA
24016-1317
US

V. Phone/Fax

Practice location:
  • Phone: 540-354-7025
  • Fax:
Mailing address:
  • Phone: 540-354-7025
  • Fax: 540-354-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE LARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-354-7025