Provider Demographics
NPI:1649422049
Name:VALLEY HOSPICE INC.
Entity Type:Organization
Organization Name:VALLEY HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,RN,CHPN
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 ST. JOSEPH ROAD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-1799
Practice Address - Country:US
Practice Address - Phone:304-242-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12251G00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005170107Medicaid