NPIMap

Organization Active NPI

Roanoke Resource LLC

  • Community/Behavioral Health Agency
  • Roanoke, VA
National Provider Identifier
1104170679
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ROANOKE RESOURCE LLC
Practice address
402 Campbell Ave SW
Roanoke, VA 24016-3627
Phone
(540) 400-7431
Fax
(540) 400-7091
NPI assigned
Nov 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Celia Lea McCauley-Wittl, DNP, FNP, PMHNPNPI 1124666078
Title
Operations Coordinator
Phone
(540) 400-7431

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
In Home Supportive Care Agency 253Z00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

402 Campbell Ave SW
Roanoke, VA 24016-3627

Mailing address

402 Campbell Ave SW
Roanoke, VA 24016-3627
Phone (540) 400-7431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181129001368 VA Part B Supplier - Clinic/Group Practice 9638413883 Receives reassigned benefits from 6 practitioners
Practice locations: Roanoke, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2217511Roanoke Resource402 Campbell Ave SW, Roanoke, VA 24016Certificate of waiverMar 21, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1104170679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 CAMPBELL AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240163627",
            "telephone_number": "540-400-7431",
            "fax_number": "540-400-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 CAMPBELL AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240163627",
            "telephone_number": "540-400-7431",
            "fax_number": "540-400-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE RESOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "MCCAULEY-WITTL",
        "authorized_official_first_name": "CELIA",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "OPERATIONS COORDINATOR",
        "authorized_official_telephone_number": "540-400-7431",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, FNP, PMHNP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.