Healthcare Provider Details

I. General information

NPI: 1467189100
Provider Name (Legal Business Name): THE VALLEY REHABILITATION AND HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 3RD AVE
MANCOS CO
81328-9079
US

IV. Provider business mailing address

575 ROUTE 70 FL 2
BRICK NJ
08723-4042
US

V. Phone/Fax

Practice location:
  • Phone: 970-533-9031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RALPH GOTTLIEB
Title or Position: MANAGER OF THE MANAGER
Credential:
Phone: 970-533-9031