Provider Demographics
NPI:1316165749
Name:CRC HEALTH
Entity type:Organization
Organization Name:CRC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:276-963-3554
Mailing Address - Street 1:366 SHORTTS RD
Mailing Address - Street 2:
Mailing Address - City:RAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:24639-9455
Mailing Address - Country:US
Mailing Address - Phone:276-963-5518
Mailing Address - Fax:
Practice Address - Street 1:111 TOWN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9622
Practice Address - Country:US
Practice Address - Phone:276-963-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002052423310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness