Provider Demographics
NPI:1821085994
Name:VALLEY-WIDE HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:VALLEY-WIDE HEALTH SYSTEMS, INC
Other - Org Name:EDWARD M. KENNEDY HEALTH 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 1:925 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1432
Mailing Address - Country:US
Mailing Address - Phone:719-852-2512
Mailing Address - Fax:719-852-3923
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:719-852-2512
Practice Address - Fax:719-852-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56836074Medicaid
COCE 9669OtherTRAVELERS MEDICARE NUMBER
COVAC 4808OtherANTHEM BCBS
CO061839Medicare ID - Type UnspecifiedFQHC PROVIDER NUMBER