Provider Demographics
NPI:1861476350
Name:VALLEY COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:VALLEY COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:VALLEY HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-296-1731
Mailing Address - Street 1:301 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8804
Mailing Address - Country:US
Mailing Address - Phone:304-296-1731
Mailing Address - Fax:304-225-2288
Practice Address - Street 1:301 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8804
Practice Address - Country:US
Practice Address - Phone:304-296-1731
Practice Address - Fax:304-225-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21101YM0800X, 251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012355Medicaid
WV9156343Medicare ID - Type UnspecifiedFAIRMONT
WV9156342Medicare ID - Type UnspecifiedMORGANTOWN
WV9156344Medicare ID - Type UnspecifiedGRAFTON
WV9156345Medicare ID - Type UnspecifiedKINGWOOD
WV3810012355Medicaid
WV9156345Medicare ID - Type UnspecifiedKINGWOOD
WV0005491002Medicaid