MEDICARE: COMMUNITY ARTSREACH

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1982544748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ARTSREACH

Provider Business Mailing Address
First Line	:	217 RUTHERFORD CT NW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-1317
Country	:	US
Telephone Number	:	540-354-7025
Fax Number	:	540-354-7025

Provider Business Practice Location Address
First Line	:	3025 FRONTIER ROAD NW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24012
Country	:	US
Telephone Number	:	540-354-7025
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BERNADETTE LARK
Credential	:
Telephone Number	:	540-354-7025

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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Directions to “COMMUNITY ARTSREACH ” Practice Location

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