Provider Demographics
NPI:1164410775
Name:VALLEY HAVEN GERIATRIC CENTER INC
Entity Type:Organization
Organization Name:VALLEY HAVEN GERIATRIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-394-5322
Mailing Address - Street 1:RD#2 BOX 44
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-9505
Mailing Address - Country:US
Mailing Address - Phone:304-394-5322
Mailing Address - Fax:304-394-1242
Practice Address - Street 1:RD#2 BOX 44
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-9505
Practice Address - Country:US
Practice Address - Phone:304-394-5322
Practice Address - Fax:304-394-1242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HAVEN GERIATRIC CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-07
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV113314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003883000Medicaid
WV515123Medicare Oscar/Certification
WV1031300001Medicare NSC