Healthcare Provider Details

I. General information

NPI: 1023025335
Provider Name (Legal Business Name): CAMPBELL COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 KABLER LANE
RUSTBURG VA
24588-0860
US

IV. Provider business mailing address

PO BOX 860
RUSTBURG VA
24588-0860
US

V. Phone/Fax

Practice location:
  • Phone: 434-332-9585
  • Fax: 434-332-9600
Mailing address:
  • Phone: 434-332-9585
  • Fax: 434-332-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number54790005K
License Number StateVA

VIII. Authorized Official

Name: MR. RICHARD M. VERILLA
Title or Position: DIRECTOR
Credential:
Phone: 434-332-9585