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
14624 SHERMAN WAY FL 6, VAN NUYS, CA 91405-2241
(818) 988-6335
(818) 988-2140
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
960000947
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HAP70682F
FAMILY PACT
CA
Enumeration date
01/23/2008
Last updated
02/22/2022
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