Organization
VALLEY HEALTH CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN A. GODWIN (CEO)
(304) 636-0133
Entity
Organization
Contact information
Practice address
46 TOWN CENTER PLZ STE A, MILL CREEK, WV 26280-9752
(304) 335-2050
(304) 335-6158
Mailing address
PO BOX 247, US ROUTE 219/250, MILL CREEK, WV 26280-0247
(304) 335-2050
(304) 335-6158
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000394653
BCBS MEDICARE FQHC #
WV
01
—
1025217
BRICKSTREET WORKERS COMP
WV
01
—
420003
VACCINE FOR CHILDREN
WV
01
—
51D0674689
CLIA
WV
05
—
5369000000
—
WV
01
—
5657280001
HEALTH NOW/DMERC/FQHC
WV
01
—
CH3574
RAILROAD MEDICARE
WV
Enumeration date
02/21/2006
Last updated
11/08/2023
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