Healthcare Provider Details

I. General information

NPI: 1699722405
Provider Name (Legal Business Name): VALLE VISTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 E MAIN ST
GREENWOOD IN
46143-1407
US

IV. Provider business mailing address

898 E MAIN ST
GREENWOOD IN
46143-1407
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-1348
  • Fax: 317-882-1631
Mailing address:
  • Phone: 317-887-1348
  • Fax: 317-882-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number307-1-PIP
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number307-0-ASR
License Number StateIN

VIII. Authorized Official

Name: STEVE FILTON JR.
Title or Position: SRVP CFO
Credential:
Phone: 610-768-3300