Basic Information
Provider Information | |||||||||
NPI: | 1770570004 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SHENANDOAH VALLEY HEALTH SERVICES LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | VALLEY HOME CARE WOODSTOCK | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1910 | ||||||||
Address2: |   | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226048060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405365229 | ||||||||
FaxNumber: | 5405364359 | ||||||||
Practice Location | |||||||||
Address1: | 762 S MAIN ST | ||||||||
Address2: |   | ||||||||
City: | WOODSTOCK | ||||||||
State: | VA | ||||||||
PostalCode: | 226641108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5404592000 | ||||||||
FaxNumber: | 5404598540 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2005 | ||||||||
LastUpdateDate: | 07/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HEISEY | ||||||||
AuthorizedOfficialFirstName: | M | ||||||||
AuthorizedOfficialMiddleName: | FRANK | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5405365260 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
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 | 060972 | 01 |   | BS TRIGON | OTHER | 1068260 | 01 |   | WV COMP | OTHER | 00239198 | 01 |   | BS MT STATE | OTHER | 21638 | 01 |   | COMMNUITY HEALTH CHN | OTHER | 2122109 | 01 |   | MAMSI | OTHER | 164072 | 01 |   | SOUTHERN HEALTH | OTHER |