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General NPI Number Information
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NPI Number | 1487730008
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Entity Type | Organization
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Legal Business Name | ROANENTERPRISES, LLC.
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5612 VININGS DR APT 106-7
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City | RICHMOND
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State | VA
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Zip | 23234-4690
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Country | US
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Telephone | 804-714-0737
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Fax | 804-622-4894
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | RICHMOND
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State | VA
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Zip | 23218-0322
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Country | US
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Telephone | 804-349-6382
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Fax | 804-622-4894
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MARVIN VAN ROANE
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Credential |
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Telephone | 804-349-6382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | SS-280-06
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License Number State | VA
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