Provider Demographics
NPI:1316063068
Name:VALLEY MEDICAL FACILITIES, INC.
Entity type:Organization
Organization Name:VALLEY MEDICAL FACILITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-749-7027
Mailing Address - Street 1:STAUNTON CLINIC INTENSIVE CASE MANAGEMENT
Mailing Address - Street 2:111 HAZEL LANE
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1253
Mailing Address - Country:US
Mailing Address - Phone:412-749-7330
Mailing Address - Fax:
Practice Address - Street 1:STAUNTON CLINIC INTENSIVE CASE MANAGEMENT
Practice Address - Street 2:111 HAZEL LANE
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1253
Practice Address - Country:US
Practice Address - Phone:412-749-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA940070251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000033550268Medicaid