Provider Demographics
NPI:1437393857
Name:VALLEY REGIONAL ENTERPRISES INC
Entity Type:Organization
Organization Name:VALLEY REGIONAL ENTERPRISES INC
Other - Org Name:VALLEY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-4310
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-8060
Mailing Address - Country:US
Mailing Address - Phone:540-536-4310
Mailing Address - Fax:540-536-2396
Practice Address - Street 1:480 EAST SOUTH COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3093
Practice Address - Country:US
Practice Address - Phone:540-635-7444
Practice Address - Fax:540-635-7787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-29
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008342332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9133887Medicaid
WV0144683002Medicaid
076082OtherBC/BS
VA9133887Medicaid