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General NPI Number Information
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NPI Number | 1003984840
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Entity Type | Organization
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Legal Business Name | NORTH ROANOKE ASSISTED LIVING
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6910 WILLIAMSON RD
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City | ROANOKE
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State | VA
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Zip | 24019-4229
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Country | US
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Telephone | 540-265-2173
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Fax | 540-777-1999
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Provider Business Mailing Address
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Address Line | 6910 WILLIAMSON RD PO BOX 19419
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City | ROANOKE
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State | VA
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Zip | 24019-4229
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Country | US
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Telephone | 540-265-2173
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Fax | 540-777-1999
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Authorized Official
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Title or Position | ADMINIOSTRATOR
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Name | MS. CATHERINE L SUTPHIN
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Credential | MSW
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Telephone | 540-265-2173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | VA
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