Organization
PIEDMONT REGIONAL COMMUNITY SERVICES BOARD
Active
Other names
Piedmont Home
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES M TOBIN (EXECUTIVE DIRECTOR)
(276) 632-7128
Entity
Organization
Contact information
Practice address
26 BOOKER ROAD, MARTINSVILLE, VA 24112-2810
(276) 632-2584
(276) 632-3110
Mailing address
24 CLAY STREET, MARTINSVILLE, VA 24112-2810
(276) 632-7128
(276) 632-0127
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
03801005
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945221
—
VA
01
—
C04131
MEDICARE GROUP NUMBER
VA
Enumeration date
09/12/2012
Last updated
09/12/2012
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