Provider Demographics
NPI:1801861083
Name:VALLEY HEALTH CARE, INC
Entity Type:Organization
Organization Name:VALLEY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-0133
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:US ROUTE 219/250
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:304-335-6158
Practice Address - Street 1:46 TOWN CENTER PLZ STE A
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-9752
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:304-335-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5369000000Medicaid
WV420003OtherVACCINE FOR CHILDREN
WVCH3574OtherRAILROAD MEDICARE
WV5657280001OtherHEALTH NOW/DMERC/FQHC
WV000394653OtherBCBS MEDICARE FQHC #
WV1025217OtherBRICKSTREET WORKERS COMP
WV51D0674689OtherCLIA
WV5118741Medicare PIN
WV420003OtherVACCINE FOR CHILDREN
WV51D0674689OtherCLIA