Provider Demographics
NPI:1508310657
Name:LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.
Entity Type:Organization
Organization Name:LUTHERAN FAMILY SERVICES OF VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-529-2762
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 1:2239 FRONT ROYAL PIKE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4731
Practice Address - Country:US
Practice Address - Phone:540-869-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA272-02-029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA272Medicaid