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General NPI Number Information
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NPI Number | 1700926573
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Entity Type | Organization
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Legal Business Name | LYNCHBURG AREA CENTER FOR INDEPENDENT LIVING
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 ALLEGHANY AVE STE 520
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City | LYNCHBURG
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State | VA
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Zip | 24501-2610
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Country | US
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Telephone | 434-528-4971
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Fax | 434-528-4976
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Provider Business Mailing Address
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Address Line | 500 ALLEGHANY AVE STE 520
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City | LYNCHBURG
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State | VA
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Zip | 24501-2610
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Country | US
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Telephone | 434-528-4971
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Fax | 434-528-4976
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PHIL THEISEN
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Credential |
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Telephone | 434-528-4971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | VA
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