Organization
MILESTONE HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOVONNE RAYNE VANCE MS, NCC (EXECUTIVE DIRECTOR)
(276) 988-0872
Entity
Organization
Contact information
Practice address
30552 GOVERNOR G C PEERY HWY, N TAZEWELL, VA 24630-8339
(276) 988-0872
(276) 988-0876
Mailing address
30552 GOVERNOR G C PEERY HWY, N TAZEWELL, VA 24630-8339
(276) 988-0872
(276) 988-0876
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
CO-434-09
VA
Other
Enumeration date
08/07/2009
Last updated
08/07/2009
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