Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Other names
Van Nuys Adult 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
14624 SHERMAN WAY, SUITE 600, VAN NUYS, CA 91405-2241
(818) 988-6335
(818) 988-2140
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
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB204579
MEDICARE PART B
CA
Enumeration date
08/09/2005
Last updated
02/23/2022
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