MEDICARE: CALM SOURCE, 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
1	324500000X	Substance Abuse Rehabilitation Facility
2	251S00000X	Community/Behavioral Health Agency	907748	VA

General Provider Information

NPI Number	:	1770948648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALM SOURCE, LLC

Provider Business Mailing Address
First Line	:	103 S MAIN ST
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-2921
Country	:	US
Telephone Number	:	434-857-2316
Fax Number	:	434-227-5430

Provider Business Practice Location Address
First Line	:	103 S MAIN ST
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-2921
Country	:	US
Telephone Number	:	434-835-2370
Fax Number	:	434-835-2028

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. LEON EDMUND ZIMMERMANN III
Credential	:
Telephone Number	:	434-835-2370

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	11/17/2025

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