Organization
MOUNT ROGERS MENTAL HEALTH & MENTAL RETARDATION SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA M UNTIEDT (REIMBURSEMENT SPECIALIST)
(276) 223-3206
Entity
Organization
Contact information
Practice address
770 W RIDGE RD, WYTHEVILLE, VA 24382-1046
(276) 223-3200
(276) 223-0617
Mailing address
770 W RIDGE RD, WYTHEVILLE, VA 24382-1046
(276) 223-3200
(276) 223-0617
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALF115839
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALF115839
LICENSED ASSISTED LIVING
VA
Enumeration date
04/23/2007
Last updated
08/22/2020
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