Provider Demographics
NPI:1740412071
Name:ROANENTEPRISES, LLC
Entity Type:Organization
Organization Name:ROANENTEPRISES, LLC
Other - Org Name:180 BOYS ADOLESCENT GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:ROANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-349-6382
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23218-0322
Mailing Address - Country:US
Mailing Address - Phone:804-213-0540
Mailing Address - Fax:804-213-0542
Practice Address - Street 1:3122 W CLAY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4728
Practice Address - Country:US
Practice Address - Phone:804-213-0540
Practice Address - Fax:804-213-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty