1255379152 NPI number — GENERATION SOLUTIONS OF THE ROANOKE VALLEY, INC

Table of content: FLOR CASTILLO RUIZ RBT (NPI 1487256301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255379152 NPI number — GENERATION SOLUTIONS OF THE ROANOKE VALLEY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERATION SOLUTIONS OF THE ROANOKE VALLEY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255379152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3825 ELECTRIC RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-4561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-776-3622
Provider Business Mailing Address Fax Number:
540-776-0694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 ELECTRIC RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24018-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-776-3622
Provider Business Practice Location Address Fax Number:
540-776-0694
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
TULANE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
434-455-6500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  05-191 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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