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General NPI Number Information
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NPI Number | 1538580873
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Entity Type | Organization
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Legal Business Name | FAMILY ALTERNATIVES LLC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 2383 OLD STAGE RD
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-2903
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Country | US
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Telephone | 804-370-6009
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 843
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-0843
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Country | US
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Telephone | 804-370-6009
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | PANSY SMITH BARNER
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Credential |
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Telephone | 804-370-6009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 2318
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License Number State | VA
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