Provider Demographics
NPI:1457397457
Name:FAMILY SERVICE OF ROANOKE VALLEY
Entity Type:Organization
Organization Name:FAMILY SERVICE OF ROANOKE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-563-5316
Mailing Address - Street 1:360 CAMPBELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3625
Mailing Address - Country:US
Mailing Address - Phone:540-563-5316
Mailing Address - Fax:540-563-5254
Practice Address - Street 1:360 CAMPBELL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3625
Practice Address - Country:US
Practice Address - Phone:540-563-5316
Practice Address - Fax:540-563-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACC0469OtherRAILROAD MEDICARE GROUP
VA1457397457Medicaid
VA240338OtherANTHEM BC/BS