Provider Demographics
NPI:1780036731
Name:VALLEY HOME CARE LLC
Entity Type:Organization
Organization Name:VALLEY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-2271
Mailing Address - Street 1:1336 25TH AVE S STE 213
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5202
Mailing Address - Country:US
Mailing Address - Phone:701-235-2271
Mailing Address - Fax:
Practice Address - Street 1:1502 BESLEY BLVD # 205
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5191
Practice Address - Country:US
Practice Address - Phone:701-235-2271
Practice Address - Fax:701-235-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health