Provider Demographics
NPI:1508854795
Name:VALLEY HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:VALLEY HEALTHCARE CENTER, LLC
Other - Org Name:VALLEY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:4840 E TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3062
Mailing Address - Country:US
Mailing Address - Phone:559-251-7161
Mailing Address - Fax:559-251-3010
Practice Address - Street 1:4840 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3062
Practice Address - Country:US
Practice Address - Phone:559-251-7161
Practice Address - Fax:559-251-3010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-11
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000161314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06225GMedicaid
CAZZR06225FMedicaid
CA056225Medicare Oscar/Certification