Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Other names
San Fernando High School Teen 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
11051 N. O'MELVENY AVE, SAN FERNANDO, CA 91340-4426
(818) 365-7517
(818) 837-6342
Mailing address
1172 N MACLAY AVE, SAN FERNANDO, CA 91340-1328
(818) 898-1388
(818) 270-9585
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/09/2005
Last updated
02/23/2022
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