Provider Demographics
NPI:1659523785
Name:AUSTIN-MILLER RESIDENTIAL
Entity Type:Organization
Organization Name:AUSTIN-MILLER RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-556-2292
Mailing Address - Street 1:3563 BRYMOOR RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2103
Mailing Address - Country:US
Mailing Address - Phone:540-793-2076
Mailing Address - Fax:540-387-0406
Practice Address - Street 1:3563 BRYMOOR RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2103
Practice Address - Country:US
Practice Address - Phone:540-793-2076
Practice Address - Fax:540-387-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA711-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health