Provider Demographics
NPI:1144277237
Name:CARILION BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:CARILION BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5125
Mailing Address - Street 1:213 S JEFFERSON ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1705
Mailing Address - Country:US
Mailing Address - Phone:540-224-5125
Mailing Address - Fax:540-985-4948
Practice Address - Street 1:213 S JEFFERSON ST
Practice Address - Street 2:SUITE 801
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1705
Practice Address - Country:US
Practice Address - Phone:540-224-5125
Practice Address - Fax:540-985-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09617Medicare Oscar/Certification
VADD8743Medicare PIN