Provider Demographics
NPI:1427041458
Name:CARILION NEW RIVER VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:CARILION NEW RIVER VALLEY MEDICAL CENTER
Other - Org Name:CARILION HOME CARE SERVICES RADFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONAL SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5352
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:707 RANDOLPH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-2443
Practice Address - Country:US
Practice Address - Phone:540-633-9330
Practice Address - Fax:540-633-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
EXEMPT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30488OtherPARTNERS
VA003693OtherBCBS
VA08061400036OtherSOUTHERN HEALTH
VA4972601Medicaid
VA=========002OtherTRICARE/CHAMPUS
VA497260BMedicare Oscar/Certification