Provider Demographics
NPI:1003320540
Name:LUTHERAN FAMILY SERVICE OF VA
Entity Type:Organization
Organization Name:LUTHERAN FAMILY SERVICE OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:EL-FREIDA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-562-8473
Mailing Address - Street 1:2609 MCVITTY RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3513
Mailing Address - Country:US
Mailing Address - Phone:540-562-8473
Mailing Address - Fax:540-774-1084
Practice Address - Street 1:1661 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-8322
Practice Address - Country:US
Practice Address - Phone:540-437-1814
Practice Address - Fax:540-615-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA272251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA272Medicaid