Provider Demographics
NPI:1205330164
Name:VALLEY RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:VALLEY RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:RIGGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-522-0400
Mailing Address - Street 1:240 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2618
Mailing Address - Country:US
Mailing Address - Phone:509-522-0400
Mailing Address - Fax:
Practice Address - Street 1:240 BUSH ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2618
Practice Address - Country:US
Practice Address - Phone:509-522-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111777901320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities