Provider Demographics
NPI:1417269465
Name:MID VALLEY MEDICAL HOME LLC
Entity Type:Organization
Organization Name:MID VALLEY MEDICAL HOME LLC
Other - Org Name:MID VALLEY PHYSICIANS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:FEATHERSTONE
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MS BSN RN
Authorized Official - Phone:503-485-0710
Mailing Address - Street 1:2995 RYAN DRIVE SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-485-0710
Mailing Address - Fax:503-485-3208
Practice Address - Street 1:198 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 210
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3489
Practice Address - Country:US
Practice Address - Phone:503-485-0710
Practice Address - Fax:503-485-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-1390251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health