1063666196 NPI number — VALLEY REGIONAL ENTERPRISES, 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 1063666196 NPI number — VALLEY REGIONAL ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY REGIONAL ENTERPRISES, 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:
6
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:
1063666196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3548
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22604-2563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-2221
Provider Business Mailing Address Fax Number:
540-678-4170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33820 OLD VALLEY PIKE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
STRASBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22657-3793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-536-2221
Provider Business Practice Location Address Fax Number:
540-678-4170
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WISEMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
540-536-4310

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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