MEDICARE: LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.

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	251S00000X	Community/Behavioral Health Agency	272-02-029	VA

General Provider Information

NPI Number	:	1871909564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.

Provider Business Mailing Address
First Line	:	2609 MCVITTY RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3513
Country	:	US
Telephone Number	:	540-562-8473
Fax Number	:	540-774-1084

Provider Business Practice Location Address
First Line	:	471 AYLOR RD
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-2486
Country	:	US
Telephone Number	:	540-450-2782
Fax Number	:	540-450-2783

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MS. FREIDA M. KING
Credential	:	BS
Telephone Number	:	540-562-8473

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	06/20/2018

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