Provider Demographics
NPI:1598213522
Name:CENTRAL VALLEY INTEGRATED HEALTHCARE
Entity Type:Organization
Organization Name:CENTRAL VALLEY INTEGRATED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:209-580-6549
Mailing Address - Street 1:731 E YOSEMITE AVE STE B146
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8039
Mailing Address - Country:US
Mailing Address - Phone:209-580-6549
Mailing Address - Fax:
Practice Address - Street 1:1901 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5042
Practice Address - Country:US
Practice Address - Phone:209-580-6549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VALLEY INTEGRATE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty