Healthcare Provider Details

I. General information

NPI: 1225107816
Provider Name (Legal Business Name): VALLEY HEALTHCARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

IV. Provider business mailing address

421 JEFFERSON ST
MORGANTOWN WV
26501-6529
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-1731
  • Fax: 304-225-2288
Mailing address:
  • Phone: 304-292-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberDP00939822
License Number StateWV

VIII. Authorized Official

Name: MRS. ALICE FAYE WILLIAMS
Title or Position: THERAPIST
Credential: LICSW
Phone: 304-296-1731