1396734893 NPI number — VALLEY-WIDE HEALTH SYSTEMS, INC

Table of content: (NPI 1396734893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396734893 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:
ERNESTO PACHECO DENTAL 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:
1396734893
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:
UNIT 1 B AT 233 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
SAN LUIS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81152-0328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-672-3352
Provider Business Mailing Address Fax Number:
719-672-3638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 1 B AT 233 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SAN LUIS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81152-0328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-672-3352
Provider Business Practice Location Address Fax Number:
719-672-3638
Provider Enumeration Date:
10/18/2005

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: 13984772 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480030 . This is a "DELTA DENTAL" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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