MEDICARE: VALLEY HAVEN GERIATRIC CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	113	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164410775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HAVEN GERIATRIC CENTER INC

Provider Business Mailing Address
First Line	:	RD#2 BOX 44
Second Line	:
City	:	WELLSBURG
State	:	WV
Zip	:	26070-9505
Country	:	US
Telephone Number	:	304-394-5322
Fax Number	:	304-394-1242

Provider Business Practice Location Address
First Line	:	RD#2 BOX 44
Second Line	:
City	:	WELLSBURG
State	:	WV
Zip	:	26070-9505
Country	:	US
Telephone Number	:	304-394-5322
Fax Number	:	304-394-1242

Authorized Official
Title or Position	:	PRESIDENT-ADMINISTRATOR
Name	:	MR. MICHAEL L ANDERSON
Credential	:
Telephone Number	:	304-394-5322

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	11/22/2011

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