MEDICARE: VALLEYLIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	017774	AZ
2	251J00000X	Nursing Care Agency	017774	AZ
3	252Y00000X	Early Intervention Provider Agency	017774	AZ
4	253Z00000X	In Home Supportive Care Agency	017774	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017774	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1245460559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEYLIFE

Provider Business Mailing Address
First Line	:	1142 W HATCHER RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-3045
Country	:	US
Telephone Number	:	602-371-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 W HATCHER RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-3045
Country	:	US
Telephone Number	:	602-371-0806
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	LINDA RABE
Credential	:
Telephone Number	:	602-371-0806

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	09/10/2009

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Directions to “VALLEYLIFE ” Practice Location

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