Basic Information
| Provider Information | |||||||||
| NPI: | 1083600142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY REGIONAL ENTERPRISES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | VALLEY HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1910 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226048060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365229 | ||||||||
| FaxNumber: | 5405364359 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 AMHERST ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365254 | ||||||||
| FaxNumber: | 5405365923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HEISEY | ||||||||
| AuthorizedOfficialFirstName: | M | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5405365260 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 2122131 | 01 | MAMSI | OTHER | 5411456064 | 01 | GWHC | OTHER | 076082 | 01 | BS TRIGON | OTHER | 120573 | 01 | SOUTHERN HEALTH | OTHER | 000219715 | 01 | BS MT STATE | OTHER | 0144683002 | 05 | WV | MEDICAID |