Provider Demographics
NPI:1164528675
Name:VALLEY CARE PROVIDERS LLC
Entity Type:Organization
Organization Name:VALLEY CARE PROVIDERS LLC
Other - Org Name:MARY KINGSBURY DBA VALLEY CARE PROVIDERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINGSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-527-5393
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-0902
Mailing Address - Country:US
Mailing Address - Phone:970-527-5393
Mailing Address - Fax:970-527-5399
Practice Address - Street 1:314 2ND STREET
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428
Practice Address - Country:US
Practice Address - Phone:970-527-5393
Practice Address - Fax:970-527-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39730361Medicaid