Mystic Meadow Group Home, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

MYSTIC MEADOW GROUP HOME, LLC

Practice address

2157 Campbell Ave
Lynchburg, VA 24501-6405

Phone

(434) 847-2001

Fax

(434) 847-2022

NPI assigned

Aug 10, 2011

Last updated

Aug 10, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Valerie A Elliott

Title

President

Phone

(434) 847-2001

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1528347358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2157 CAMPBELL AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245016405",
            "telephone_number": "434-847-2001",
            "fax_number": "434-847-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2157 CAMPBELL AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245016405",
            "telephone_number": "434-847-2001",
            "fax_number": "434-847-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MEADOW GROUP HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-847-2001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jon Christopher Myers, D.O.
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• Timothy Mynes, DO
• Mystic Meadows Home Care Services LLC
• Ardalan Nabizadeh
• Morgan Rose Nails, DC
• Colleen Nakamura, PA
• Janell Parks Napier, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; 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.