1811011109 NPI number — HIDDEN VALLEY NSG AND REHABCTR.

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 1811011109 NPI number — HIDDEN VALLEY NSG AND REHABCTR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIDDEN VALLEY NSG AND REHABCTR.
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:
1811011109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 RICHARDS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK HILL
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25901-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK HILL
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25901-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-465-1903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BIBB
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
LPTA
Authorized Official Telephone Number:
304-465-1903

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  481 , 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)





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