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
23763 VALENCIA BLVD., VALENCIA, CA 91355
(661) 287-1551
(661) 255-8037
Mailing address
1172 N. MACLAY AVE., SAN FERNANDO, CA 91340
(818) 898-1388
(818) 365-4031
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP70650F
CANCER DETECTION PROGRAM
CA
Enumeration date
01/23/2008
Last updated
03/03/2022
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