Basic Information
| Provider Information | |||||||||
| NPI: | 1891732079 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY HOPE ASSOCIATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 510 | ||||||||
| Address2: | 103 SOUTH WABASH | ||||||||
| City: | NORTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858775111 | ||||||||
| FaxNumber: | 7858772199 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 SOUTH WABASH | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858775111 | ||||||||
| FaxNumber: | 7858772199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ERBERT | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CONTRACT ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 7858775111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | Y | Hospital Units | Rehabilitation, Substance Use Disorder Unit |
ID Information
| ID | Type | State | Issuer | Description | 461414 | 01 | VALUE OPTIONS PROVIDER NO | OTHER |