Provider Demographics
NPI:1427054535
Name:VALLEY REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:VALLEY REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:860-651-3381
Mailing Address - Street 1:110 HOPMEADOW ST
Mailing Address - Street 2:STE 300
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9407
Mailing Address - Country:US
Mailing Address - Phone:860-651-3381
Mailing Address - Fax:860-651-0037
Practice Address - Street 1:110 HOPMEADOW ST
Practice Address - Street 2:STE 300
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089-9407
Practice Address - Country:US
Practice Address - Phone:860-651-3381
Practice Address - Fax:860-651-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01708Medicare PIN