Provider Demographics
NPI:1952424566
Name:VALLEY SPRINGS ENTERPRISES, INC.
Entity Type:Organization
Organization Name:VALLEY SPRINGS ENTERPRISES, INC.
Other - Org Name:VALLEY SPRINGS YOUTH RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-269-4291
Mailing Address - Street 1:RR 1 BOX 127
Mailing Address - Street 2:
Mailing Address - City:BLACK
Mailing Address - State:MO
Mailing Address - Zip Code:63625-9704
Mailing Address - Country:US
Mailing Address - Phone:573-269-4291
Mailing Address - Fax:573-269-4202
Practice Address - Street 1:525 COUNTY ROAD 816
Practice Address - Street 2:
Practice Address - City:BLACK
Practice Address - State:MO
Practice Address - Zip Code:63625-9115
Practice Address - Country:US
Practice Address - Phone:573-269-4291
Practice Address - Fax:573-269-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QC1500X, 322D00000X
MO000660323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO489582863Medicaid