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General NPI Number Information
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NPI Number | 1497279434
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Entity Type | Organization
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Legal Business Name | RESILIENT HEALTH AND COMMUNITY SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 300 FRANKLIN ST STE 231
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2162
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Country | US
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Telephone | 276-224-0949
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4202
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City | MARTINSVILLE
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State | VA
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Zip | 24115-4202
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Country | US
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Telephone | 276-224-0949
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. RAYMOND V TAYAG
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Credential |
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Telephone | 276-224-0949
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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 | 2696-03-001
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License Number State | VA
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