Provider Demographics
NPI:1700103827
Name:PETALUMA VALLEY HEARING CENTER
Entity Type:Organization
Organization Name:PETALUMA VALLEY HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PILTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-762-0103
Mailing Address - Street 1:106 LYNCH CREEK WAY
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2356
Mailing Address - Country:US
Mailing Address - Phone:866-853-3499
Mailing Address - Fax:
Practice Address - Street 1:106 LYNCH CREEK WAY
Practice Address - Street 2:SUITE 9A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2356
Practice Address - Country:US
Practice Address - Phone:866-853-3499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management