1801861083 NPI number — VALLEY HEALTH CARE, INC

Table of content: (NPI 1801861083)

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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