Provider Demographics
NPI:1285896894
Name:VALLEY HEALTH SERVICES INC ADC
Entity type:Organization
Organization Name:VALLEY HEALTH SERVICES INC ADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BETRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-866-3330
Mailing Address - Street 1:690 W GERMAN ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2135
Mailing Address - Country:US
Mailing Address - Phone:315-866-3330
Mailing Address - Fax:315-866-6546
Practice Address - Street 1:690 W GERMAN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2135
Practice Address - Country:US
Practice Address - Phone:315-866-3330
Practice Address - Fax:315-866-6546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-26
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2124301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01281098Medicaid