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General NPI Number Information
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NPI Number | 1104170679
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Entity Type | Organization
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Legal Business Name | ROANOKE RESOURCE LLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 402 CAMPBELL AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-3627
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Country | US
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Telephone | 540-400-7431
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Fax | 540-400-7091
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Provider Business Mailing Address
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Address Line | 402 CAMPBELL AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-3627
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Country | US
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Telephone | 540-400-7431
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Fax | 540-400-7091
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Authorized Official
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Title or Position | OPERATIONS COORDINATOR
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Name | MRS. CELIA LEA MCCAULEY-WITTL
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Credential | DNP, FNP, PMHNP
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Telephone | 540-400-7431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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