Healthcare Provider Details

I. General information

NPI: 1649422049
Provider Name (Legal Business Name): VALLEY HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MOUNT ST. JOSEPH ROAD
WHEELING WV
26003-1799
US

IV. Provider business mailing address

10686 STATE ROUTE 150
RAYLAND OH
43943-7847
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-1977
  • Fax:
Mailing address:
  • Phone: 740-859-5650
  • Fax: 740-859-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number12
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number12
License Number StateWV

VIII. Authorized Official

Name: MS. CYNTHIA BOUGHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSN,RN,CHPN
Phone: 740-859-5650