MEDICARE: VALLE VISTA, LLC

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	283Q00000X	Psychiatric Hospital	307-1-PIP	IN
2	283Q00000X	Psychiatric Hospital	307-0-ASR	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699722405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLE VISTA, LLC

Provider Business Mailing Address
First Line	:	898 E MAIN ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1407
Country	:	US
Telephone Number	:	317-887-1348
Fax Number	:	317-882-1631

Provider Business Practice Location Address
First Line	:	898 E MAIN ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1407
Country	:	US
Telephone Number	:	317-887-1348
Fax Number	:	317-882-1631

Authorized Official
Title or Position	:	SRVP CFO
Name	:	STEVE FILTON JR.
Credential	:
Telephone Number	:	610-768-3300

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	03/27/2012

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Directions to “VALLE VISTA, LLC ” Practice Location

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