Provider Demographics
NPI:1629852959
Name:WARRIORS HEART VIRGINIA
Entity Type:Organization
Organization Name:WARRIORS HEART VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-274-8889
Mailing Address - Street 1:756 PURPLE SAGE RD
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-3981
Mailing Address - Country:US
Mailing Address - Phone:702-274-1835
Mailing Address - Fax:
Practice Address - Street 1:20500 DEVASYA LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:VA
Practice Address - Zip Code:22514-2867
Practice Address - Country:US
Practice Address - Phone:702-274-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder