Provider Demographics
NPI:1750315396
Name:HOSPICE OF THE VALLEY, INC.
Entity Type:Organization
Organization Name:HOSPICE OF THE VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYS DIR PAYOR ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:979 TIBBETTS WICK RD STE A
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1182
Mailing Address - Country:US
Mailing Address - Phone:330-788-1992
Mailing Address - Fax:
Practice Address - Street 1:979 TIBBETTS WICK RD STE A
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1182
Practice Address - Country:US
Practice Address - Phone:330-788-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0056HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820213Medicaid
OH0820213Medicaid