Healthcare Provider Details

I. General information

NPI: 1558415117
Provider Name (Legal Business Name): TOTAL ACTION AGAINST POVERTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CAMPBELL AVE SW SUITE 601
ROANOKE VA
24011-1211
US

IV. Provider business mailing address

145 CAMPBELL AVE SW SUITE 601
ROANOKE VA
24011-1211
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-6781
  • Fax: 540-345-4461
Mailing address:
  • Phone: 540-345-6781
  • Fax: 540-345-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE J. EDLICH
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 650-345-6781