MEDICARE: VALLEYBROOK CLINIC, 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	261Q00000X	Clinic/Center	261Q00000X	OH

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	:	1659570406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEYBROOK CLINIC, INC.

Provider Business Mailing Address
First Line	:	2526 N REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-2820
Country	:	US
Telephone Number	:	419-537-1485
Fax Number	:	419-531-8518

Provider Business Practice Location Address
First Line	:	2526 N REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-2820
Country	:	US
Telephone Number	:	419-537-1485
Fax Number	:	419-531-8518

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KARYL L MCANINCH
Credential	:
Telephone Number	:	419-537-1620

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/01/2010

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