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General NPI Number Information
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NPI Number | 1427027341
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES OF THE VALLEYS - ROANOKE
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 2502 MELROSE AVENUE NW
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City | ROANOKE
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State | VA
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Zip | 24017
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Country | US
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Telephone | 540-581-0620
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Fax | 540-581-0628
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Provider Business Mailing Address
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Address Line | 2502 MELROSE AVENUE NW SUITE A
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City | ROANOKE
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State | VA
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Zip | 24017
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Country | US
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Telephone | 540-581-0620
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Fax | 540-581-0628
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. BRUCE PHIPPS
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Credential |
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Telephone | 540-581-0620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 24002006
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License Number State | VA
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