Organization
ESHCOL BROOK HOMES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY L FIELDS (CHIEF EXECUTIVE OFFICER)
(276) 728-3121
Entity
Organization
Contact information
Practice address
747 LONGVIEW LN, GALAX, VA 24333-2154
(276) 728-3121
Mailing address
747 LONGVIEW LANE, GALAX, VA 24333-2154
(276) 728-3121
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1282-01-001
VA
Other
Enumeration date
07/23/2010
Last updated
07/23/2010
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