Healthcare Provider Details

I. General information

NPI: 1073244810
Provider Name (Legal Business Name): VALLEY HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MAIN ST
BEVERLY WV
26253-9621
US

IV. Provider business mailing address

PO BOX 247
MILL CREEK WV
26280-0247
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-0133
  • Fax:
Mailing address:
  • Phone: 304-335-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JORDAN A. GODWIN
Title or Position: CEO
Credential:
Phone: 304-335-2050