Active NPI
Our Lady of the Valley, Inc.
- Skilled Nursing Facility
- Roanoke, VA
National Provider Identifier
1245330299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH2650
- Legal business name
- OUR LADY OF THE VALLEY, INC.
- Practice address
- 650 N Jefferson St
Roanoke, VA 24016-1427 - Phone
- (540) 345-5111
- Fax
- (540) 985-6561
- NPI assigned
- Sep 22, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Lee Blair
- Title
- President
- Phone
- (540) 989-9604
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH2650 | VA | Primary |
Addresses
Primary practice location
650 N Jefferson St
Roanoke, VA 24016-1427
Mailing address
650 N Jefferson St
Roanoke, VA 24016-1427
Phone (540) 345-5111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4953567 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040211000513 | VA | Part A Provider - Skilled Nursing Facility | 6103710041 | Practice locations: Roanoke, VA |
Skilled nursing facility certification: CCN 495357
- Legal name
- OUR LADY OF THE VALLEY, INC.
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 2001
- Last certification
- Aug 25, 2023
- Beds
- 70
- Ownership / control type
- Church Related
- Organization structure
- Corporation
- Incorporated
- Nov 26, 1988 in VA
- Enrollment address
- 650 N Jefferson St
Roanoke, VA 24016-1427 - Nursing home name
- OUR LADY OF THE VALLEY
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Our Lady Of The Valley
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Church related
- Certified
- Oct 1, 2001
- Medicare certification status
- Active
- Certified beds
- 70
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D0231482 | Our Lady of the Valley | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Denise White | Operational/Managerial Control | Nov 4, 2011 | |
| Mary McNichols | W-2 Managing Employee | Nov 26, 1988 | |
| David Rawlings | Operational/Managerial Control | Nov 4, 2011 | |
| Other | Dec 5, 2021 | 50% |
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1740441600000",
"number": "1245330299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 N JEFFERSON ST",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240161427",
"telephone_number": "540-345-5111",
"fax_number": "540-985-6561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 N JEFFERSON ST",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240161427",
"telephone_number": "540-345-5111",
"fax_number": "540-985-6561"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OUR LADY OF THE VALLEY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-22",
"last_updated": "2025-02-25",
"certification_date": "2025-02-25",
"status": "A",
"authorized_official_last_name": "BLAIR",
"authorized_official_first_name": "LEE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "540-989-9604",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "VA",
"license": "NH2650",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4953567",
"state": "VA"
}
],
"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 Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.