Provider Demographics
NPI:1669646436
Name:VALLEY PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:VALLEY PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:TARESHAWTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:330-757-7160
Mailing Address - Street 1:3685 HUNTERS HL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5306
Mailing Address - Country:US
Mailing Address - Phone:330-757-7160
Mailing Address - Fax:330-757-7169
Practice Address - Street 1:3685 HUNTERS HL
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-5306
Practice Address - Country:US
Practice Address - Phone:330-757-7160
Practice Address - Fax:330-757-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2850802Medicaid
OH9360531Medicare PIN