Provider Demographics
NPI:1558638601
Name:VALLEY HEALTH TEAM, INC.
Entity Type:Organization
Organization Name:VALLEY HEALTH TEAM, INC.
Other - Org Name:FIREBAUGH COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOYLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNA-GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:559-693-2462
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:21890 COLORADO AVE
Mailing Address - City:SAN JOAQUIN
Mailing Address - State:CA
Mailing Address - Zip Code:93660-0737
Mailing Address - Country:US
Mailing Address - Phone:559-693-2462
Mailing Address - Fax:559-693-4382
Practice Address - Street 1:689 N ST
Practice Address - Street 2:
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2156
Practice Address - Country:US
Practice Address - Phone:559-693-2462
Practice Address - Fax:559-659-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001856261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-1176Medicare PIN