Goodwill Industries of the Valleys - Roanoke

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

24002006 Issued in VA

Legal business name

GOODWILL INDUSTRIES OF THE VALLEYS - ROANOKE

Practice address

2502 Melrose Avenue NW
Roanoke, VA 24017

Phone

(540) 581-0620

Fax

(540) 581-0628

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Bruce Phipps

Title

President and Ceo

Phone

(540) 581-0620

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Goodwill Industries of the Valleys4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Goodwill Industries of the Valleys

  • Developmentally Disabled Services Day Training Agency
  • Staunton, VA
  • NPI 1518360775
  NPD tax ID
• Goodwill Industries of the Valleys - Radford

  • Developmentally Disabled Services Day Training Agency
  • Radford, VA
  • NPI 1285762229
  NPD tax ID
• Goodwill Industries of the Valleys - Rocky Mount

  • Developmentally Disabled Services Day Training Agency
  • Rocky Mount, VA
  • NPI 1801993118
  NPD tax ID

Locations

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1427027341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 MELROSE AVENUE NW",
            "address_2": "SUITE A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24017",
            "telephone_number": "540-581-0620",
            "fax_number": "540-581-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 MELROSE AVENUE NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24017",
            "telephone_number": "540-581-0620",
            "fax_number": "540-581-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWILL INDUSTRIES OF THE VALLEYS - ROANOKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2015-05-29",
        "status": "A",
        "authorized_official_last_name": "PHIPPS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "540-581-0620",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "VA",
            "license": "24002006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004946928",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004947444",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Angel Goodman, PA
• Eli Nathan Goodman, M.D.
• Michelle Page Goodman, PMHNP-BC
• Dasha'Nae Nekole Goodrich
• Mackenzie Goodrich, DO
• Corey Goodwin, PHARMD
• Megan Goodwin, PHARMD
• Justin Reece Goolcharan, M.D.
• Douglas James Gordon, DO
• Jared Junior Jacob Gordon, MD

• Developmentally Disabled Services Day Training Agency in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Developmentally Disabled Services Day Training Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.