MBK Residential Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MBK RESIDENTIAL SERVICES LLC

Practice address

6740 Thirlane Rd
Roanoke, VA 24019-2908

Phone

(864) 414-7251

NPI assigned

Apr 5, 2022

Last updated

Jun 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Nicole Calhoun-Smith

Title

Director

Phone

(864) 414-7251

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1689315707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6740 THIRLANE RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240192908",
            "telephone_number": "864-414-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6740 THIRLANE RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240192908",
            "telephone_number": "864-414-7251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1510 Grayson Ave NW",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240173734",
            "country_code": "US",
            "telephone_number": "540-400-8036",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1311 Melrose Ave NW",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240174109",
            "country_code": "US",
            "telephone_number": "540-981-1398",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2307 Melrose Ave NW",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240173905",
            "country_code": "US",
            "telephone_number": "540-566-3702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MBK RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "CALHOUN-SMITH",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "864-414-7251",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donnie Elwood Mayhew, D.D.S.
• Leah W Mayne, LCSW
• Mazen Madhoun MD LLC
• Bethany Mazurek, BCBA/LBA
• Concilia Mbawuike, CNP
• Kelly McAllister
• Dane C McBride, MD
• Mark A McBride, M.D.
• Niya L McCaden
• Grace Chung-Yee McCarthy, M.D.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.