| Organization Name: | NORTHEAST VALLEY HEALTH CORPORATION |
| NPI Number: | 1114928595 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY WYARD (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 12756 Van Nuys Blvd Pacoima |
| State: | CA US |
| Postal Code: | 913311626 |
| Phone Number: | 8188960531 |
| Fax Number: | 8188965850 |
| NPI Enumeration Date: | 08/09/2005 |
| NPI Last Update Date: | 07/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 9600189 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |