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Organization

NORTHEAST VALLEY HEALTH CORPORATION

Active
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Organization

NORTHEAST VALLEY HEALTH CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KIMBERLY WYARD (CHIEF 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
261QF0050X
Non-Surgical Family Planning Clinic/Center
Primary
960000124
CA
261QF0400X
Federally Qualified Health Center (FQHC)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
HAP11580F
FAMILY PACT
CA
Enumeration date
01/22/2008
Last updated
02/22/2022
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