Provider Demographics
NPI:1912006404
Name:VALLEY FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:VALLEY FAMILY HEALTH CENTER
Other - Org Name:MATERNAL & CHILD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:559-867-4416
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-0543
Mailing Address - Country:US
Mailing Address - Phone:559-867-4416
Mailing Address - Fax:559-867-3010
Practice Address - Street 1:275 S MADERA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1403
Practice Address - Country:US
Practice Address - Phone:559-846-5240
Practice Address - Fax:559-846-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53945FMedicaid
CAHAP53945FMedicaid
CAHAP53945FMedicaid