Provider Demographics
NPI:1366467375
Name:LONG VALLEY HEALTH CENTER
Entity Type:Organization
Organization Name:LONG VALLEY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:GRAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-984-6131
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:LAYTONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95454-0870
Mailing Address - Country:US
Mailing Address - Phone:707-984-6131
Mailing Address - Fax:707-984-6990
Practice Address - Street 1:50 BRANSCOMB ROAD
Practice Address - Street 2:
Practice Address - City:LAYTONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95454
Practice Address - Country:US
Practice Address - Phone:707-984-6131
Practice Address - Fax:707-984-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70034FMedicaid
ZZZ84629ZOtherNHIC
CAFHC70034FMedicaid