Provider Demographics
NPI:1699829069
Name:CONNEAUT VALLEY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CONNEAUT VALLEY HEALTH CENTER, INC.
Other - Org Name:VALLEY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-373-2923
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-2923
Mailing Address - Fax:814-333-5640
Practice Address - Street 1:906 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONNEAUTVILLE
Practice Address - State:PA
Practice Address - Zip Code:16406-7138
Practice Address - Country:US
Practice Address - Phone:814-373-2284
Practice Address - Fax:814-373-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
PA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVA045197OtherUNITED CONCORDIA