Provider Demographics
NPI:1316541865
Name:CENTRAL VALLEY HEALTH PLAN, INC.
Entity Type:Organization
Organization Name:CENTRAL VALLEY HEALTH PLAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:PRUSAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-450-3375
Mailing Address - Street 1:1303 EAST HERNDON AVENUE
Mailing Address - Street 2:MAIL STOP 500
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-450-3000
Mailing Address - Fax:559-450-5585
Practice Address - Street 1:1303 EAST HERNDON AVENUE
Practice Address - Street 2:MAIL STOP 500
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-450-3000
Practice Address - Fax:559-450-5585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT AGNES MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization