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ROANOKE RESOURCE LLC
NPI 1104170679
Community/Behavioral Health in Roanoke, VA

Active since November 05, 2012CLIA 49D2217511 · Waiver
402 CAMPBELL AVE SW, ROANOKE, VA 24016(540) 400-7431(540) 400-7091 Get Directions Write a Review

NPPES record last updated: January 7, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 7, 2025, Dec 11, 2019 (2 updates tracked since 2019).

About Roanoke Resource Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROANOKE RESOURCE LLC (NPI 1104170679) is a healthcare organization registered as a community/behavioral health in Roanoke, Virginia and active in the NPI registry since November 2012. The organization holds a CLIA Waiver certificate valid through March 21, 2027 and lists Celia Lea Mccauley-wittl, Operations Coordinator, as its authorized official.

NPPES Registry Identity

NPI1104170679
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NameROANOKE RESOURCE LLC
Location Address402 CAMPBELL AVE SWRoanoke, VA 24016-3627
Mailing Address402 Campbell Ave SwRoanoke, VA 24016-3627 · (540) 400-7431 · Fax (540) 400-7091
Phone(540) 400-7431
Fax(540) 400-7091
Organization SubpartNo
Authorized OfficialCelia Lea Mccauley-wittlOperations Coordinator · (540) 400-7431
Enumeration DateNovember 5, 2012
Last NPPES UpdateJanuary 7, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 7, 2025
✔ NPI 1104170679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Also ListedIn Home Supportive CareTaxonomy 253Z00000X
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
402 CAMPBELL AVE SW, Roanoke, VA 24016
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Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Roanoke Resource Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Roanoke Resource LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Celia Mccauley-Wittl, DNP, FNP-BC, PMHNP
Nurse Practitioner
NPI 1124666078
402 CAMPBELL AVE SW
Roanoke, VA 24016
(540) 400-7431
✔ PECOS✔ Accepts MedicareSame address
Courtni Sandras-Gaut, LCSW
Clinical Social Worker
NPI 1639695380
402 CAMPBELL AVE SW
Roanoke, VA 24016
(540) 400-7431
✔ PECOSSame address
Gwendolyn Spangler, NP-C
Nurse Practitioner
NPI 1003346412
402 CAMPBELL AVE SW
Roanoke, VA 24016
(540) 400-7431
✔ PECOS✔ Accepts MedicareSame address
Ellen Weber
Nurse Practitioner
NPI 1023909785
402 CAMPBELL AVE SW
Roanoke, VA 24016
(540) 400-7431
✔ PECOS✔ Accepts MedicareSame address
Samantha Hall
Nurse Practitioner
NPI 1235786674
1906 BELLEVIEW AVE SE
Roanoke, VA 24014
(540) 981-7000
✔ PECOS✔ Accepts Medicare1.4 mi
James Olsen, CMHC, LPC
Mental Health Counselor
NPI 1770248726
5965 S 900 E STE 100
Murray, UT 84121
(801) 639-9146
✔ PECOS✔ Accepts Medicare1,727 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2217511

Roanoke Resource · Roanoke, VA
Active · expires Mar 21, 2027
CLIA Number49D2217511
Laboratory TypeBehavioral Health
Certificate Effective DateMarch 22, 2025
Certificate Expiration DateMarch 21, 2027
Laboratory DirectorCelia L. Mccauley-Wittl
Laboratory Phone(540) 400-7431
Laboratory LocationRoanoke Resource402 Campbell Ave SW, Roanoke, VA 24016
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roanoke Resource LLC's NPI number?

The NPI number for Roanoke Resource LLC is 1104170679. It was assigned to this organization in the NPPES registry on November 5, 2012.

Where is Roanoke Resource LLC located?

Roanoke Resource LLC is located at 402 Campbell Ave SW, Roanoke, VA 24016. The listed phone number is (540) 400-7431.

What is Roanoke Resource LLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Is Roanoke Resource LLC enrolled in Medicare?

Yes. Roanoke Resource LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Roanoke Resource LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 3 Medicare specialties reassign their Medicare billing to Roanoke Resource LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4), Clinical Social Worker (1) and Mental Health Counselor (1). Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Roanoke Resource LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2217511) is associated with this NPI, valid through March 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Roanoke Resource LLC was last updated on January 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.