Basic Information
Provider Information
NPI: 1013149665
EntityType: 2
ReplacementNPI:  
OrganizationName: NEW RIVER SERVICE AUTHORITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: NEW RIVER BEHAVVIORAL HEALTHCARE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 895 STATE FARM RD
Address2: SUITE 508
City: BOONE
State: NC
PostalCode: 286074917
CountryCode: US
TelephoneNumber: 8282649007
FaxNumber: 8282625687
Practice Location
Address1: 524 SIGNAL HILL DRIVE EXT
Address2:  
City: STATESVILLE
State: NC
PostalCode: 286254391
CountryCode: US
TelephoneNumber: 7048711045
FaxNumber: 7048838638
Other Information
ProviderEnumerationDate: 08/17/2009
LastUpdateDate: 08/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ANDREWS
AuthorizedOfficialFirstName: PATRICIA
AuthorizedOfficialMiddleName: P
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 3363724095
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMHL-049-108NCY193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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