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General NPI Number Information
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NPI Number | 1447481437
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Entity Type | Organization
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Legal Business Name | MILESTONE HOUSE, LLC
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 30552 GOVERNOR G C PEERY HWY
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City | N TAZEWELL
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State | VA
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Zip | 24630-8339
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Country | US
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Telephone | 276-988-0872
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Fax | 276-988-0876
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Provider Business Mailing Address
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Address Line | 30552 GOVERNOR G C PEERY HWY
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City | N TAZEWELL
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State | VA
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Zip | 24630-8339
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Country | US
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Telephone | 276-988-0872
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Fax | 276-988-0876
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LOVONNE RAYNE VANCE
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Credential | MS, NCC
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Telephone | 276-988-0872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CO-434-09
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License Number State | VA
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