Provider Demographics
NPI:1306268297
Name:VALENTINE LONG TERM CARE LLC
Entity type:Organization
Organization Name:VALENTINE LONG TERM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RHONNY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:318-270-5001
Mailing Address - Street 1:407 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2405
Mailing Address - Country:US
Mailing Address - Phone:318-270-5001
Mailing Address - Fax:318-270-2273
Practice Address - Street 1:407 POLK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2405
Practice Address - Country:US
Practice Address - Phone:318-270-5001
Practice Address - Fax:318-270-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy