Provider Demographics
NPI:1477979722
Name:UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Entity Type:Organization
Organization Name:UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-646-6618
Mailing Address - Street 1:3875 W BEECHWOOD AVE
Mailing Address - Street 2:ATTN MANAGED CARE
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-876-6705
Practice Address - Street 1:429 E MANNING AVE
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2668
Practice Address - Country:US
Practice Address - Phone:559-924-2015
Practice Address - Fax:559-925-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002830OtherSTATE OF CA DEPARTMENT OF PUBLIC HEALTH
CA1477979722Medicaid
CA550002830OtherSTATE OF CA DEPARTMENT OF PUBLIC HEALTH