Provider Demographics
NPI:1114593415
Name:VALLEY REGIONAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:VALLEY REGIONAL ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-4310
Mailing Address - Street 1:220 CAMPUS BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:351 VALLEY HEALTH WAY STE 210
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-6480
Practice Address - Country:US
Practice Address - Phone:540-635-0736
Practice Address - Fax:540-635-0893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy