Organization
ORCHARD MOUNTAIN RECOVERY LLC
Active
Organization
ORCHARD MOUNTAIN RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL WILLIAM LUSTER NCAC II, CSAC, SAP (COO)
(434) 282-2294
Entity
Organization
Contact information
Practice address
355 RIO RD W STE 203, CHARLOTTESVILLE, VA 22901-1361
(434) 282-2294
(434) 282-2644
Mailing address
355 RIO RD W STE 203, CHARLOTTESVILLE, VA 22901-1361
(434) 282-2294
(434) 282-2644
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
2877-02-001
VA
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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