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NPI Code Detail

MEDICARE: NIRVANA RESIDENTIAL SERVICES LLC

MEDICARE: NIRVANA RESIDENTIAL SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1194225037
Entity Type Code : Organization
Provider Name (Legal Business Name) : NIRVANA RESIDENTIAL SERVICES LLC
Provider Business Mailing Address
First Line : 1325 SMARTVIEW LN
Second Line :
City : FOREST
State : VA
Zip : 24551-1099
Country : US
Telephone Number : 434-237-7717
Fax Number : 434-237-5668
Provider Business Practice Location Address
First Line : 1325 SMARTVIEW LN
Second Line :
City : FOREST
State : VA
Zip : 24551-1099
Country : US
Telephone Number : 434-237-7717
Fax Number : 434-237-5668
Authorized Official
Title or Position : DIRECTOR
Name : STACEY BROWN
Credential :
Telephone Number : 434-237-7717
Provider Enumeration Date : 02/16/2018
Last Update Date : 02/16/2018

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Directions to “NIRVANA RESIDENTIAL SERVICES LLC ” Practice Location

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