PACOIMA HEALTH CENTER – NPI #1114928595
Clinic/Center

PACOIMA HEALTH CENTER is an AHC clinic located in PACOIMA, CA. NPPES has assigned the NPI number 1114928595 to PACOIMA HEALTH CENTER on August 09, 2005. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “PACOIMA HEALTH CENTER” is a dba name, the actual legal business name for this organization is NORTHEAST VALLEY HEALTH CORPORATION. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 4 years ago on Feb 22, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PACOIMA HEALTH CENTER below.

NPI Profile for
NORTHEAST VALLEY HEALTH CORPORATION

NPI Number
1114928595
Enumeration Date

(about 21 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
NORTHEAST VALLEY HEALTH CORPORATION
Doing Business As (dba): PACOIMA HEALTH CENTER
Primary location
12756 VAN NUYS BLVD
PACOIMA, CA 91331-1626
Phone: (818) 896-0531 Fax: (818) 896-5850
Mailing address
1172 N MACLAY AVE
SAN FERNANDO, CA 91340-1328
Phone: (818) 898-1388 Fax: (818) 365-4031
Organization Subpart
No
Authorized Official
KIMBERLY WYARD
CHIEF EXECUTIVE OFFICER
Phone: (818) 898-1388
Updated
Certification Date
Feb 22, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for PACOIMA HEALTH CENTER

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERMINW14819A
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.