Provider Demographics
NPI:1285744474
Name:VALLEY VIEW HAVEN
Entity type:Organization
Organization Name:VALLEY VIEW HAVEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:DEVERELL
Authorized Official - Last Name:PEACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-935-2105
Mailing Address - Street 1:105 MALTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17029
Mailing Address - Country:US
Mailing Address - Phone:717-248-3988
Mailing Address - Fax:171-248-2780
Practice Address - Street 1:105 MALTA DRIVE
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17029
Practice Address - Country:US
Practice Address - Phone:717-248-3988
Practice Address - Fax:171-248-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA343430310400000X
PA130302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007565600004Medicaid
PA395102Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER