Basic Information
| Provider Information | |||||||||
| NPI: | 1447280359 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY HOPE ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BOONVILLE IOP VALLEY HOPE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 510 | ||||||||
| Address2: | 103 S WABASH AVE | ||||||||
| City: | NORTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676540510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858775111 | ||||||||
| FaxNumber: | 7858772322 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 W ASHLEY RD | ||||||||
| Address2: | |||||||||
| City: | BOONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652330398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608826547 | ||||||||
| FaxNumber: | 6608822391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ERBERT | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CONTRACT ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 7858775111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 3090-10684 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 461414 | 01 | VALUE OPTIONS PROVIDER NO | OTHER |