Healthcare Provider Details

I. General information

NPI: 1144659657
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E PALL MALL ST
WINCHESTER VA
22601-4575
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: 540-562-8473
  • Fax: 540-774-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number272
License Number StateVA

VIII. Authorized Official

Name: MRS. FREIDA MAY KING
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 540-562-8473