Provider Demographics
NPI:1568087476
Name:CARILION HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:CARILION HEALTHCARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONAL SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5352
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5372
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:1375 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-5011
Practice Address - Country:US
Practice Address - Phone:276-228-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARILION HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-16
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health