Provider Demographics
NPI:1497150593
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:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-646-6618
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:RAISIN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93652-0069
Mailing Address - Country:US
Mailing Address - Phone:559-233-0111
Mailing Address - Fax:559-233-0112
Practice Address - Street 1:6425 W BOWLES
Practice Address - Street 2:
Practice Address - City:RAISIN CITY
Practice Address - State:CA
Practice Address - Zip Code:93652-0069
Practice Address - Country:US
Practice Address - Phone:559-233-0111
Practice Address - Fax:559-233-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)