NPIMap

Organization Active NPI

Goodwill Industries of the Valleys - Rocky Mount

  • Developmentally Disabled Services Day Training Agency
  • Rocky Mount, VA
National Provider Identifier
1801993118
Registry record updated May 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
240 Issued in VA
Legal business name
GOODWILL INDUSTRIES OF THE VALLEYS - ROCKY MOUNT
Doing business as
Goodwill Industries of the Valleys Southern Division
Practice address
1045 North Main Street
Rocky Mount, VA 24151
Phone
(540) 483-9559
Fax
(540) 483-0297
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2015

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

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 240 VA Primary

Addresses

Primary practice location

1045 North Main Street
Rocky Mount, VA 24151

Mailing address

2502 Melrose Avenue NW
Suite a
Roanoke, VA 24017
Phone (540) 581-0620

Other identifiers 1

IdentifierTypeStateIssuer
004947339MedicaidVA

Other names 1

  • Goodwill Industries of the Valleys Southern Division Doing business as

National Provider Directory

National Provider Directory
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.

Locations

2502 Melrose Ave NW
#A
Roanoke, VA 24017

1045 N Main St
Rocky Mount, VA 24151
Phone (540) 483-9559

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1801993118",
    "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": "1045 NORTH MAIN STREET",
            "city": "ROCKY MOUNT",
            "state": "VA",
            "postal_code": "24151",
            "telephone_number": "540-483-9559",
            "fax_number": "540-483-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWILL INDUSTRIES OF THE VALLEYS - ROCKY MOUNT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "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": "240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004947339",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodwill Industries of the Valleys Southern Division",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocky Mount, VA

Sources for this page

  • 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.