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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