Provider Demographics
NPI:1417944729
Name:VALLEY-WIDE HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:VALLEY-WIDE HEALTH SYSTEMS, INC
Other - Org Name:SAN LUIS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-5161
Mailing Address - Street 1:233 MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN LUIS
Mailing Address - State:CO
Mailing Address - Zip Code:81152
Mailing Address - Country:US
Mailing Address - Phone:719-672-3352
Mailing Address - Fax:719-672-3638
Practice Address - Street 1:233 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LUIS
Practice Address - State:CO
Practice Address - Zip Code:81152
Practice Address - Country:US
Practice Address - Phone:719-672-3352
Practice Address - Fax:719-672-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13984772Medicaid
COCE 9669OtherTRAVELERS MEDICARE NUMBER
CO05638200Medicaid
COVAC 4808OtherANTHEM BCBS
CO061819Medicare ID - Type UnspecifiedFQHC PROVIDER NUMBER