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
7107 REMMET AVE, CANOGA PARK, CA 91303
(818) 340-3570
(818) 702-9578
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
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP70652F
CANCER DETECTION PROGRAM
CA
Enumeration date
01/23/2008
Last updated
02/23/2022
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