1821085994 NPI number — VALLEY-WIDE HEALTH SYSTEMS, INC

Table of content: (NPI 1821085994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821085994 NPI number — VALLEY-WIDE HEALTH SYSTEMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY-WIDE HEALTH SYSTEMS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDWARD M. KENNEDY HEALTH CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821085994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 2ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTE VISTA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81144-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-852-2512
Provider Business Mailing Address Fax Number:
719-852-3923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTE VISTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81144-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-852-2512
Provider Business Practice Location Address Fax Number:
719-852-3923
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARNOLDI
Authorized Official First Name:
JANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
719-589-5161

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 56836074 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE 9669 . This is a "TRAVELERS MEDICARE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: VAC 4808 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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