Healthcare Provider Details

I. General information

NPI: 1447496344
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICE OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 VIRGINIA AVENUE CHARLOTTE DEHART ELEMENTARY
WINCHESTER VA
22601
US

IV. Provider business mailing address

2609 MCVITTY RD
ROANOKE VA
24018-3513
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-2782
  • Fax: 540-450-2783
Mailing address:
  • Phone: 540-774-7100
  • Fax: 540-774-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number272-02-029
License Number StateVA

VIII. Authorized Official

Name: MRS. FREIDA M. KING
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 540-774-7100