Provider Demographics
NPI:1720360944
Name:NEW RIVER SERVICE AUTHORITY
Entity Type:Organization
Organization Name:NEW RIVER SERVICE AUTHORITY
Other - Org Name:NEW RIVER BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER PANEL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-733-5889
Mailing Address - Street 1:895 STATE FARM ROAD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4917
Mailing Address - Country:US
Mailing Address - Phone:828-264-9007
Mailing Address - Fax:828-733-8743
Practice Address - Street 1:132 POPLAR GROVE CONNECTOR
Practice Address - Street 2:SUITE B
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5915
Practice Address - Country:US
Practice Address - Phone:828-264-8759
Practice Address - Fax:828-733-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency