Provider Demographics
NPI:1235310384
Name:MOUNTAIN VALLEYS HEALTH CENTERS INC
Entity Type:Organization
Organization Name:MOUNTAIN VALLEYS HEALTH CENTERS INC
Other - Org Name:BURNEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-999-9010
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0277
Mailing Address - Country:US
Mailing Address - Phone:530-999-9010
Mailing Address - Fax:530-294-5392
Practice Address - Street 1:554-850 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BIEBER
Practice Address - State:CA
Practice Address - Zip Code:96009
Practice Address - Country:US
Practice Address - Phone:530-999-9010
Practice Address - Fax:530-294-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2023-07-28
Deactivation Date:2018-05-08
Deactivation Code:
Reactivation Date:2018-05-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP03915FMedicaid