Basic Information
| Provider Information | |||||||||
| NPI: | 1073598439 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY MEDICAL FACILITIES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | HERITAGE VALLEY KENNEDY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776161 | ||||||||
| FaxNumber: | 4127776189 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776161 | ||||||||
| FaxNumber: | 4127776189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROSENBERGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7247734730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 150401 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1007502820014 | 05 | PA | MEDICAID | P008461 | 01 | CHAMPUS | OTHER | 0146416 | 05 | OH | MEDICAID | 1007502820024 | 05 | PA | MEDICAID | 0169494000 | 05 | WV | MEDICAID | 374735 | 01 | BLACK LUNG | OTHER | 1007502820003 | 05 | PA | MEDICAID |