Provider Demographics
NPI:1275225708
Name:VALLEY HEALTHCARE
Entity Type:Organization
Organization Name:VALLEY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KERUBO
Authorized Official - Middle Name:HAPPINESS
Authorized Official - Last Name:KINARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-660-5117
Mailing Address - Street 1:9299 W OLIVE AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8383
Mailing Address - Country:US
Mailing Address - Phone:410-660-5117
Mailing Address - Fax:
Practice Address - Street 1:9299 W OLIVE AVE STE 404
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8383
Practice Address - Country:US
Practice Address - Phone:410-660-5117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health