Provider Demographics
NPI:1083389472
Name:CAFORRAL AGENCY, LLC
Entity Type:Organization
Organization Name:CAFORRAL AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:LLANA
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-203-5755
Mailing Address - Street 1:113 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1437
Mailing Address - Country:US
Mailing Address - Phone:434-203-5755
Mailing Address - Fax:434-724-7224
Practice Address - Street 1:6600 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:DRY FORK
Practice Address - State:VA
Practice Address - Zip Code:24549-5114
Practice Address - Country:US
Practice Address - Phone:434-203-5755
Practice Address - Fax:434-724-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities