Healthcare Provider Details

I. General information

NPI: 1003149915
Provider Name (Legal Business Name): VALLEY GERICARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 PENN FOREST BLVD STE 518
ROANOKE VA
24018-4374
US

IV. Provider business mailing address

424 GRAVES MILL RD SUITE 400
LYNCHBURG VA
24502-4651
US

V. Phone/Fax

Practice location:
  • Phone: 540-989-3613
  • Fax:
Mailing address:
  • Phone: 434-846-3832
  • Fax: 434-846-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLICAM C WARD
Title or Position: OWNER
Credential: MD
Phone: 540-493-7200