Organization Name: | NORTHEAST VALLEY HEALTH CORPORATION |
NPI Number: | 1235130600 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY WYARD (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 1600 San Fernando Rd San Fernando |
State: | CA US |
Postal Code: | 913403115 |
Phone Number: | 8183658086 |
Fax Number: | 8188984826 |
NPI Enumeration Date: | 08/09/2005 |
NPI Last Update Date: | 07/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | 9600124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |