Provider Demographics
NPI:1487730008
Name:ROANENTERPRISES, LLC.
Entity type:Organization
Organization Name:ROANENTERPRISES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:804-349-6382
Mailing Address - Fax:804-622-4894
Practice Address - Street 1:5612 VININGS DR APT 106-7
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-4690
Practice Address - Country:US
Practice Address - Phone:804-714-0737
Practice Address - Fax:804-622-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-280-06322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children