Provider Demographics
NPI:1992039499
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:RCHD INFANT AND TODDLER CONNECTION OF ROANOKE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER C
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN-TIMITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-283-5050
Mailing Address - Street 1:1502 WILLIAMSON RD NE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-5130
Mailing Address - Country:US
Mailing Address - Phone:540-283-5050
Mailing Address - Fax:540-857-7316
Practice Address - Street 1:1502 WILLIAMSON RD NE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5130
Practice Address - Country:US
Practice Address - Phone:540-283-5050
Practice Address - Fax:540-857-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency