1629570320 NPI number — MOUNTAIN VALLEYS HEALTH CENTERS

Table of content: (NPI 1629570320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629570320 NPI number — MOUNTAIN VALLEYS HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN VALLEYS HEALTH CENTERS
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:
Provider Other Organization Name Type Code:
6
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:
1629570320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIEBER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96009-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-999-9010
Provider Business Mailing Address Fax Number:
530-294-5392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 OLD MCCLOUD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT SHASTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96067-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-999-9040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
530-999-9010

Provider Taxonomy Codes

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

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

  • Identifier: 1629570320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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