Provider Demographics
NPI:1770948648
Name:CALM SOURCE, LLC
Entity type:Organization
Organization Name:CALM SOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:ZIMMERMANN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:434-835-2370
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2921
Mailing Address - Country:US
Mailing Address - Phone:434-857-2316
Mailing Address - Fax:434-227-5430
Practice Address - Street 1:1045 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1800
Practice Address - Country:US
Practice Address - Phone:434-835-2370
Practice Address - Fax:434-835-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
VA907748251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility