Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Other names
Canoga Park 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
7107 REMMET AVE, CANOGA PARK, CA 91303-2016
(818) 340-3570
(818) 702-9578
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
9600963
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14819B
MIN
—
Enumeration date
08/09/2005
Last updated
03/03/2022
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