Wall Residences, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

071-01-001 Issued in VA

Legal business name

WALL RESIDENCES, LLC

Practice address

1281 Huckleberry Ridge Rd NE
Floyd, VA 24091-2037

Phone

(540) 745-4216

Fax

(540) 745-5367

NPI assigned

Jul 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jack Wall

Title

Executive Director

Phone

(540) 745-4216

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea F Carter

  • Behavior Analyst
  • Salem, VA
  • NPI 1144995259
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063436723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1281 HUCKLEBERRY RIDGE RD NE",
            "city": "FLOYD",
            "state": "VA",
            "postal_code": "240912037",
            "telephone_number": "540-745-4216",
            "fax_number": "540-745-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1281 HUCKLEBERRY RIDGE RD NE",
            "city": "FLOYD",
            "state": "VA",
            "postal_code": "240912037",
            "telephone_number": "540-745-4216",
            "fax_number": "540-745-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALL RESIDENCES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "540-745-4216",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "071-01-001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wesley Christopher Weber, RN
• Ann E. Willoughby, M.S., CCC-SLP
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• Bethany Yoder, P.T.
• Shelley Kaye Youngblood, MS, OTR/L

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Floyd, VA
• Providers in Floyd, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.