1225508369 NPI number — VALERIA HEALTH, LLC

Table of content: (NPI 1225508369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225508369 NPI number — VALERIA HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALERIA HEALTH, LLC
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:
YOUCOSE HEALTH
Provider Other Organization Name Type Code:
3
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:
1225508369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSONVILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97070-0091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-847-9952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SW 116TH AVE
Provider Second Line Business Practice Location Address:
4TH FLOOR, RM 109
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-847-9952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RECH
Authorized Official First Name:
VALERIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-840-0671

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500759378 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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