Healthcare Provider Details

I. General information

NPI: 1508798083
Provider Name (Legal Business Name): REBUILDING THE COMMUNITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 E ATLANTIC ST STE C
SOUTH HILL VA
23970-9547
US

IV. Provider business mailing address

1163 E ATLANTIC ST STE C
SOUTH HILL VA
23970-9547
US

V. Phone/Fax

Practice location:
  • Phone: 434-207-8730
  • Fax: 804-800-4943
Mailing address:
  • Phone: 434-207-8730
  • Fax: 804-800-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY DAGNER
Title or Position: CEO/OWNER
Credential:
Phone: 434-207-8730