Provider Demographics
NPI:1396369310
Name:VALLEY PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:VALLEY PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:631-278-3782
Mailing Address - Street 1:13954 W WADDELL RD STE 103-470
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8750
Mailing Address - Country:US
Mailing Address - Phone:623-236-0084
Mailing Address - Fax:
Practice Address - Street 1:14365 W GREER ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4355
Practice Address - Country:US
Practice Address - Phone:631-278-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health