Provider Demographics
NPI:1437671161
Name:VALLEY HOSPICE, INC
Entity Type:Organization
Organization Name:VALLEY HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-859-5650
Mailing Address - Street 1:10686 STATE ROUTE 150
Mailing Address - Street 2:
Mailing Address - City:RAYLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43943-7847
Mailing Address - Country:US
Mailing Address - Phone:740-859-5650
Mailing Address - Fax:740-859-5695
Practice Address - Street 1:308 MOUNT SAINT JOSEPH RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2349
Practice Address - Country:US
Practice Address - Phone:740-859-5650
Practice Address - Fax:740-859-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019153Medicaid