Provider Demographics
NPI:1629335583
Name:VALLEY-WIDE HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:VALLEY-WIDE HEALTH SYSTEMS, INC.
Other - Org Name:EDWARD M KENNEDY HEALTH DENTAL CLINIC
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 1:128 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2290
Mailing Address - Country:US
Mailing Address - Phone:719-589-5161
Mailing Address - Fax:719-589-5722
Practice Address - Street 1:925 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1432
Practice Address - Country:US
Practice Address - Phone:719-852-4533
Practice Address - Fax:719-852-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56836074Medicaid
CO05638200Medicaid