Provider Demographics
NPI:1801886809
Name:VALLEY HEALTH ENTERPRISES, INC.
Entity type:Organization
Organization Name:VALLEY HEALTH ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-223-3300
Mailing Address - Street 1:1319 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-3630
Mailing Address - Country:US
Mailing Address - Phone:815-220-1682
Mailing Address - Fax:815-220-1685
Practice Address - Street 1:1319 4TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-3630
Practice Address - Country:US
Practice Address - Phone:815-220-1682
Practice Address - Fax:815-220-1685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HEALTH ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-21
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000246332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05019559OtherBLUE CROSS BLUE SHIELD
IL=========002Medicaid
IL0324680002Medicare ID - Type Unspecified