Provider Demographics
NPI:1861101958
Name:VALLEY LIVING SOLUTIONS LLC
Entity type:Organization
Organization Name:VALLEY LIVING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA, NASMCPT
Authorized Official - Phone:601-506-1953
Mailing Address - Street 1:116 BROOKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5763
Mailing Address - Country:US
Mailing Address - Phone:601-255-1626
Mailing Address - Fax:
Practice Address - Street 1:1507 HARDY ST STE 104
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4978
Practice Address - Country:US
Practice Address - Phone:601-255-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care