Basic Information
| Provider Information | |||||||||
| NPI: | 1326339862 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY MEDICAL FACILITIES, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | HERITAGE VALLEY KENNEDY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776161 | ||||||||
| FaxNumber: | 4127776838 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776161 | ||||||||
| FaxNumber: | 4127776838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2011 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROSENBERGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7247734730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 273R00000X | PA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 1007502820024 | 05 | PA | MEDICAID | 1007502820003 | 05 | PA | MEDICAID | 1007502820014 | 05 | PA | MEDICAID | 0169494000 | 05 | WV | MEDICAID | P008461 | 01 | PA | CHAMPUS | OTHER | 0146416 | 05 | OH | MEDICAID | 374735 | 01 | PA | BLACK LUNG | OTHER |