Provider Demographics
NPI:1972711398
Name:FRIENDSHIP OUTPATIENT & WELLNESS SERVICES, INC.
Entity Type:Organization
Organization Name:FRIENDSHIP OUTPATIENT & WELLNESS SERVICES, INC.
Other - Org Name:FRIENDSHIP OUTPATIENT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-777-4044
Mailing Address - Street 1:P.O. BOX 7577
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-0577
Mailing Address - Country:US
Mailing Address - Phone:540-265-2185
Mailing Address - Fax:540-265-2051
Practice Address - Street 1:391 HERSHBERGER RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1983
Practice Address - Country:US
Practice Address - Phone:540-265-2199
Practice Address - Fax:540-265-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496718Medicare Oscar/Certification