NORTHEAST VALLEY HEALTH CORPORATION NPI 1053312587

NPI Information

NORTHEAST VALLEY HEALTH CORPORATION is a federally qualified health center (fqhc) clinic center in Pacoima, CA. NORTHEAST VALLEY HEALTH CORPORATION NPI is 1053312587. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Maclay Wellness Center.

The provider's business location address is:

12451 W. GAIN STREET
PACOIMA, CA
ZIP 91331
Phone: (818) 897-2193
Fax: (818) 890-2394

The provider's authorized official is Kimberly Wyard .
The authorized official title is Chief Executive Officer and has the following contact phone number (818) 898-1388.

The CLIA number assigned to this NPI record is 05D2189010 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/9/2005 and was last updated on 2/22/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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