Healthcare Provider Details

I. General information

NPI: 1437291853
Provider Name (Legal Business Name): VALLEY MEDICAL FACILITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 RUSSELLWOOD AVE STAUNTON CLINIC- MCKEES ROCKS
MC KEES ROCKS PA
15136-3020
US

IV. Provider business mailing address

618 RUSSELLWOOD AVE STAUNTON CLINIC- MCKEES ROCKS
MC KEES ROCKS PA
15136-3020
US

V. Phone/Fax

Practice location:
  • Phone: 412-771-7610
  • Fax:
Mailing address:
  • Phone: 412-771-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number940070
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1000033550172
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0924
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE CROSS

VIII. Authorized Official

Name: MR. DONALD EDWARD KLINE SR.
Title or Position: VICE PRESIDENT, CFO
Credential:
Phone: 412-749-7010