Provider Demographics
NPI:1346441151
Name:CENTRAL VALLEY MATERNAL & CHILD CARE CENTERS
Entity Type:Organization
Organization Name:CENTRAL VALLEY MATERNAL & CHILD CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-867-4416
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-0543
Mailing Address - Country:US
Mailing Address - Phone:559-867-4416
Mailing Address - Fax:559-867-3010
Practice Address - Street 1:1274 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2956
Practice Address - Country:US
Practice Address - Phone:559-584-2342
Practice Address - Fax:559-582-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061021Medicaid