Provider Demographics
NPI:1508903105
Name:VALLEY HEALTH ENTERPRISE
Entity Type:Organization
Organization Name:VALLEY HEALTH ENTERPRISE
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MORSCHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:815-224-4555
Mailing Address - Street 1:920 WEST ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2763
Mailing Address - Country:US
Mailing Address - Phone:815-224-4555
Mailing Address - Fax:815-223-8349
Practice Address - Street 1:920 WEST ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2763
Practice Address - Country:US
Practice Address - Phone:815-224-4555
Practice Address - Fax:815-223-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-009021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0324680001Medicare ID - Type Unspecified
0324680001Medicare NSC