Provider Demographics
NPI:1629364351
Name:SPRING VALLEY FAMILY CARE
Entity Type:Organization
Organization Name:SPRING VALLEY FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KESNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:540-877-6763
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:WV
Practice Address - Zip Code:26763
Practice Address - Country:US
Practice Address - Phone:540-877-6763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55323261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care