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General NPI Number Information
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NPI Number | 1639228778
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Entity Type | Organization
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Legal Business Name | PHC OF VIRGINIA, LLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 125 KNOTBREAK RD
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City | SALEM
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State | VA
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Zip | 24153-5404
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Country | US
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Telephone | 540-389-4761
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Fax | 540-404-4531
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Provider Business Mailing Address
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Address Line | 6100 TOWER CIR STE 1000
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City | FRANKLIN
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State | TN
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Zip | 37067-1509
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Country | US
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Telephone | 615-861-6000
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Fax |
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Authorized Official
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Title or Position | VP & SECRETARY
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Name | BRIAN P FARLEY
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Credential |
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Telephone | 615-861-6000
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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 | 324500000X
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License Number State | VA
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