Healthcare Provider Details

I. General information

NPI: 1245330299
Provider Name (Legal Business Name): OUR LADY OF THE VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

IV. Provider business mailing address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-5111
  • Fax: 540-985-6561
Mailing address:
  • Phone: 540-345-5111
  • Fax: 540-985-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2650
License Number StateVA

VIII. Authorized Official

Name: MRS. LEE BLAIR
Title or Position: PRESIDENT
Credential:
Phone: 540-989-9604