=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790838670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURY HOMES RESIDENTIAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 DANDRIDGE DRIVE
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-385-4181
-----------------------------------------------------
Fax | 434-385-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 DANDRIDGE DRIVE
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-385-4181
-----------------------------------------------------
Fax | 434-385-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. BLANCHE FOSTER LAURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-546-3449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------