Provider Demographics
NPI:1447227673
Name:ARCH ROANOKE
Entity Type:Organization
Organization Name:ARCH ROANOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALI
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMED-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:540-344-8060
Mailing Address - Street 1:404 ELM AVENUE, SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016
Mailing Address - Country:US
Mailing Address - Phone:540-344-8060
Mailing Address - Fax:540-344-4695
Practice Address - Street 1:1109 FRANKLIN ROAD, SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016
Practice Address - Country:US
Practice Address - Phone:540-344-8060
Practice Address - Fax:540-344-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA021324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility