Provider Demographics
NPI:1558444505
Name:AVANTE AT ROANOKE, INC.
Entity Type:Organization
Organization Name:AVANTE AT ROANOKE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-987-7180
Mailing Address - Street 1:4000 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 540 NORTH
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6751
Mailing Address - Country:US
Mailing Address - Phone:954-987-7180
Mailing Address - Fax:954-989-5287
Practice Address - Street 1:324 KING GEORGE AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5213
Practice Address - Country:US
Practice Address - Phone:540-345-8139
Practice Address - Fax:540-345-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2491314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4960734Medicaid
VA4951565Medicaid
VA495156Medicare Oscar/Certification