Provider Demographics
NPI:1598383309
Name:VALLEY RIDGE HOME HEALTH LLC
Entity Type:Organization
Organization Name:VALLEY RIDGE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:IDELS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:516-855-5504
Mailing Address - Street 1:1195 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2316
Mailing Address - Country:US
Mailing Address - Phone:516-855-5504
Mailing Address - Fax:
Practice Address - Street 1:53 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2941
Practice Address - Country:US
Practice Address - Phone:540-443-1111
Practice Address - Fax:540-552-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health