Provider Demographics
NPI:1699041566
Name:GARDNER FAMILY HEALTH NETWORK INC
Entity Type:Organization
Organization Name:GARDNER FAMILY HEALTH NETWORK INC
Other - Org Name:GARDNER DOWNTOWN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-935-3971
Mailing Address - Street 1:160 E. VIRGINIA STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5865
Mailing Address - Country:US
Mailing Address - Phone:408-918-2682
Mailing Address - Fax:408-278-7799
Practice Address - Street 1:725 E. SANTA CLARA STREET
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1900
Practice Address - Country:US
Practice Address - Phone:408-918-2682
Practice Address - Fax:408-278-7799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARDNER FAMILY HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-26
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751005Medicaid