Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Other names
PEDIATRIC HEALTH AND WIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY WYARD (CHIEF EXECUTIVE OFFICER)
(818) 898-1388
Entity
Organization
Contact information
Practice address
7138 VAN NUYS BLVD, VAN NUYS, CA 91405-3005
(818) 778-6240
(818) 994-8005
Mailing address
1172 N MACLAY AVE, SAN FERNANDO, CA 91340-1328
(818) 898-1388
(818) 365-4031
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/09/2005
Last updated
02/22/2022
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