Organization
WALL RESIDENCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK WALL (EXECUTIVE DIRECTOR)
(540) 745-4216
Entity
Organization
Contact information
Practice address
1281 HUCKLEBERRY RIDGE RD NE, FLOYD, VA 24091-2037
(540) 745-4216
(540) 745-5367
Mailing address
1281 HUCKLEBERRY RIDGE RD NE, FLOYD, VA 24091-2037
(540) 745-4216
(540) 745-5367
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
071-01-001
VA
Other
Enumeration date
07/27/2006
Last updated
08/22/2020
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