Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Other names
PACOIMA HEALTH 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
12756 VAN NUYS BLVD, PACOIMA, CA 91331-1626
(818) 896-0531
(818) 896-5850
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
—
—
261QC1500X
Community Health Clinic/Center
9600189
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14819A
MIN
—
Enumeration date
08/09/2005
Last updated
02/22/2022
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