Provider Demographics
NPI:1659570406
Name:VALLEYBROOK CLINIC, INC.
Entity Type:Organization
Organization Name:VALLEYBROOK CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCANINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-537-1620
Mailing Address - Street 1:2526 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2820
Mailing Address - Country:US
Mailing Address - Phone:419-537-1485
Mailing Address - Fax:419-531-8518
Practice Address - Street 1:2526 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2820
Practice Address - Country:US
Practice Address - Phone:419-537-1485
Practice Address - Fax:419-531-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH210855Medicaid