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General NPI Number Information
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NPI Number | 1659523785
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Entity Type | Organization
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Legal Business Name | AUSTIN-MILLER RESIDENTIAL
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 3563 BRYMOOR RD SW
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City | ROANOKE
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State | VA
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Zip | 24018-2103
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Country | US
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Telephone | 540-793-2076
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Fax | 540-387-0406
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Provider Business Mailing Address
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Address Line | 3563 BRYMOOR RD SW
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City | ROANOKE
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State | VA
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Zip | 24018-2103
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Country | US
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Telephone | 540-793-2076
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Fax | 540-387-0406
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Authorized Official
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Title or Position | OWNER
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Name | KIRBY CAMPBELL
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Credential |
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Telephone | 540-556-2292
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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 | 711-03-001
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License Number State | VA
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