Healthcare Provider Details

I. General information

NPI: 1689926099
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CEDARMEADE AVE
WINCHESTER VA
22601-3469
US

IV. Provider business mailing address

2609 MCVITTY RD
ROANOKE VA
24018-3513
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-3575
  • Fax: 540-662-8449
Mailing address:
  • Phone: 540-774-7100
  • 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: MS. FREIDA MAE KING
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 540-562-8473