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Shawana Roach
Intellectual and/or Developmental Disabilities Residential Treatment Facility in Disputanta, Virginia
NPI 1790276186

Shawana Roach is a Intellectual and/or Developmental Disabilities Residential Treatment Facility based in Disputanta, VA. Shawana Roach practices in Disputanta, VA. The NPI Number for Shawana Roach is 1790276186 and holds a License No. 2452--01-001 (Virginia).

The current practice location address for Shawana Roach is 10424 Walton Lake Rd, Disputanta, VA and can be reached out via phone at 757-477-0424.

Location: 10424 Walton Lake Rd, Disputanta, VA, 23842-4703
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790276186
Provider Name
Shawana Roach
Credential
Provider Entity Type
Individual
Gender
Female
Address
10424 Walton Lake Rd, Disputanta, VA, 23842-4703
Phone Number
757-477-0424
Fax Number
Provider Enumeration Date
05/22/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
10424 Walton Lake Rd
City
Disputanta
State
Virginia
Zip
23842-4703
Phone Number
757-477-0424
Fax Number
person
Provider Business Mailing Address Details
Address
10424 Walton Lake Rd
City
Disputanta
State
Virginia
Zip
23842-4703
Phone Number
757-477-0424
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
2452--01-001 (Virginia)
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
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