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Organization Active NPI

Innovage Virginia Pace - Roanoke Valley, LLC

Doing business as InnovAge Virginia PACE - Roanoke Valley

  • PACE Provider Organization
  • Roanoke, VA
National Provider Identifier
1346684974
Registry record updated Apr 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
INNOVAGE VIRGINIA PACE - ROANOKE VALLEY, LLC
Doing business as
InnovAge Virginia PACE - Roanoke Valley
Practice address
5251 Concourse Dr
Roanoke, VA 24019-3081
Phone
(540) 904-2817
Fax
(540) 682-5946
NPI assigned
Apr 25, 2013
Organization subpart
Yes
Parent organization
TOTAL COMMUNITY OPTIONS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2018

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

Authorized official

Name
Mr. Josh D. McGilliard
Title
Regional Executive Director
Phone
(540) 595-6563

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X VA Primary

Addresses

Primary practice location

5251 Concourse Dr
Roanoke, VA 24019-3081

Mailing address

5251 Concourse Dr
Roanoke, VA 24019-3081
Phone (540) 904-2817

Other names 1

  • InnovAge Virginia PACE - Roanoke Valley Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1366848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523577600000",
    "number": "1346684974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5251 CONCOURSE DR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240193081",
            "telephone_number": "540-904-2817",
            "fax_number": "540-682-5946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5251 CONCOURSE DR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240193081",
            "telephone_number": "540-904-2817",
            "fax_number": "540-682-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVAGE VIRGINIA PACE - ROANOKE VALLEY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TOTAL COMMUNITY OPTIONS, INC.",
        "enumeration_date": "2013-04-25",
        "last_updated": "2018-04-13",
        "status": "A",
        "authorized_official_last_name": "MCGILLIARD",
        "authorized_official_first_name": "JOSH",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "REGIONAL EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "540-595-6563",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InnovAge Virginia PACE - Roanoke Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.