| Organization Name: | NORTHEAST VALLEY HEALTH CORPORATION |
| NPI Number: | 1013199264 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY WYARD (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 7223 N. Fair Avenue Sun Valley |
| State: | CA US |
| Postal Code: | 91352 |
| Phone Number: | 8184324400 |
| Fax Number: | 8187647930 |
| NPI Enumeration Date: | 11/29/2007 |
| NPI Last Update Date: | 01/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |