| Roanoke Resource Llc | |
|
402 Campbell Ave Sw Roanoke VA 24016-3627 | |
| (540) 400-7431 | |
| (540) 400-7091 |
| Full Name | Roanoke Resource Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 402 Campbell Ave Sw, Roanoke, Virginia |
| Authorized Official Name and Position | Celia Lea Mccauley-wittl (OPERATIONS COORDINATOR) |
| Authorized Official Contact | 5404007431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roanoke Resource Llc 402 Campbell Ave Sw Roanoke VA 24016-3627 Ph: (540) 400-7431 | Roanoke Resource Llc 402 Campbell Ave Sw Roanoke VA 24016-3627 Ph: (540) 400-7431 |
| NPI Number | 1104170679 |
|---|---|
| Provider Enumeration Date | 11/05/2012 |
| Last Update Date | 12/11/2019 |
| Certification Date | 12/11/2019 |
| Medicare PECOS PAC ID | 9638413883 |
|---|---|
| Medicare Enrollment ID | O20181129001368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104170679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
| Provider Name | Celia Lea Mccauley-wittl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124666078 PECOS PAC ID: 6406190669 Enrollment ID: I20210223000377 |
| Provider Name | James D Olsen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770248726 PECOS PAC ID: 6103266028 Enrollment ID: I20240425002205 |
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