Provider Demographics
NPI:1053619742
Name:VALLEY REGIONAL HEALTH SERVICES L3C
Entity type:Organization
Organization Name:VALLEY REGIONAL HEALTH SERVICES L3C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-664-1372
Mailing Address - Street 1:600 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1512
Mailing Address - Country:US
Mailing Address - Phone:815-664-1328
Mailing Address - Fax:815-664-1406
Practice Address - Street 1:4391 VENTURE DR
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1014
Practice Address - Country:US
Practice Address - Phone:815-664-1328
Practice Address - Fax:815-664-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory