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General NPI Number Information
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NPI Number | 1144631110
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Entity Type | Organization
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Legal Business Name | EAGLES NEST REGENERATION INC.
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 148 REHOBOTH LN NE
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City | FLOYD
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State | VA
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Zip | 24091-1130
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Country | US
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Telephone | 540-745-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 148 REHOBOTH LN NE
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City | FLOYD
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State | VA
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Zip | 24091-1130
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Country | US
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Telephone | 540-745-4001
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. GRANT HINSON
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Credential | MA, CSAC
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Telephone | 540-745-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | VA
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