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Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY WYARD (CHEIF EXECUTIVE OFFICER)
(818) 898-1388
Entity
Organization
Contact information
Practice address
1600 SAN FERNANDO ROAD, SAN FERNANDO, CA 91340
(818) 365-8086
(818) 898-4826
Mailing address
1172 N. MACLAY AVE., SAN FERNANDO, CA 91340
(818) 898-1388
(818) 365-4031
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
960000124
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP11580F
CANCER DETECTION PROGRAM
CA
Enumeration date
01/22/2008
Last updated
02/22/2022
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