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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