Organization
GOODWILL INDUSTRIES OF THE VALLEYS - ROANOKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE PHIPPS (PRESIDENT AND CEO)
(540) 581-0620
Entity
Organization
Contact information
Practice address
2502 MELROSE AVENUE NW, ROANOKE, VA 24017
(540) 581-0620
(540) 581-0628
Mailing address
2502 MELROSE AVENUE NW, SUITE A, ROANOKE, VA 24017
(540) 581-0620
(540) 581-0628
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
24002006
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004946928
—
VA
05
—
004947444
—
VA
Enumeration date
03/14/2006
Last updated
05/29/2015
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