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General NPI Number Information
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NPI Number | 1477363216
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Entity Type | Organization
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Legal Business Name | LIFELINE COMMUNITY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 57 DUPONT RD
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City | MARTINSVILLE
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State | VA
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Zip | 24112-4618
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Country | US
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Telephone | 276-806-8982
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Fax |
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Provider Business Mailing Address
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Address Line | 406 HARRIS DR
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1712
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Country | US
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Telephone | 276-806-8982
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DEREK BROWN
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Credential |
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Telephone | 276-806-8982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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