1801861083 NPI number — VALLEY HEALTH CARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801861083 NPI number — VALLEY HEALTH CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY HEALTH CARE, 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:
1801861083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247
Provider Second Line Business Mailing Address:
US ROUTE 219/250
Provider Business Mailing Address City Name:
MILL CREEK
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26280-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-335-2050
Provider Business Mailing Address Fax Number:
304-335-6158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 TOWN CENTER PLZ STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26280-9752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-335-2050
Provider Business Practice Location Address Fax Number:
304-335-6158
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GODWIN
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-636-0133

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5369000000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 420003 . This is a "VACCINE FOR CHILDREN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: CH3574 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 5657280001 . This is a "HEALTH NOW/DMERC/FQHC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000394653 . This is a "BCBS MEDICARE FQHC #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1025217 . This is a "BRICKSTREET WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51D0674689 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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