Provider Demographics
NPI:1407032352
Name:ROANOKE VALLEY SPECIAL SERVICES INC
Entity Type:Organization
Organization Name:ROANOKE VALLEY SPECIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BA
Authorized Official - Phone:252-536-0700
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:GARYSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27831-0443
Mailing Address - Country:US
Mailing Address - Phone:252-536-0702
Mailing Address - Fax:
Practice Address - Street 1:505 OLD HIGHWAY
Practice Address - Street 2:
Practice Address - City:GARYSBURG
Practice Address - State:NC
Practice Address - Zip Code:27831-0443
Practice Address - Country:US
Practice Address - Phone:252-536-0702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301881BMedicaid