Healthcare Provider Details

I. General information

NPI: 1053828079
Provider Name (Legal Business Name): VALLEY RESPIRATORY AND HOME SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 STANLEY BLVD
YAKIMA WA
98902-3753
US

IV. Provider business mailing address

818 N 24TH AVE
YAKIMA WA
98902-1703
US

V. Phone/Fax

Practice location:
  • Phone: 509-941-5191
  • Fax: 509-834-7414
Mailing address:
  • Phone: 509-895-5415
  • Fax: 509-834-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ERIK DAVID MICKELSON
Title or Position: OWNER
Credential:
Phone: 509-941-5191