Provider Demographics
NPI:1306991567
Name:ROANOKE COUNTY BOARD OF SUPERVISORS
Entity type:Organization
Organization Name:ROANOKE COUNTY BOARD OF SUPERVISORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-387-6042
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-387-6087
Mailing Address - Fax:540-387-6210
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-387-6087
Practice Address - Fax:540-387-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-03
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-03
Provider Licenses
StateLicense IDTaxonomies
VA8741328251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8741328Medicaid