Healthcare Provider Details

I. General information

NPI: 1750315396
Provider Name (Legal Business Name): HOSPICE OF THE VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 TIBBETTS WICK RD STE A
GIRARD OH
44420-1182
US

IV. Provider business mailing address

979 TIBBETTS WICK RD STE A
GIRARD OH
44420-1182
US

V. Phone/Fax

Practice location:
  • Phone: 330-788-1992
  • Fax:
Mailing address:
  • Phone: 330-788-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0056HSP
License Number StateOH

VIII. Authorized Official

Name: KIMBERLY M RALSTON
Title or Position: SYS DIR PAYOR ADMIN
Credential:
Phone: 419-996-5119