Provider Demographics
NPI:1205465747
Name:HEALING GROVE HEALTH CENTER INC., A SOCIAL PURPOSE CORPORATION
Entity type:Organization
Organization Name:HEALING GROVE HEALTH CENTER INC., A SOCIAL PURPOSE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:JUNE HO
Authorized Official - Last Name:THIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-398-6318
Mailing Address - Street 1:448 GOODYEAR ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3201
Mailing Address - Country:US
Mailing Address - Phone:408-583-6338
Mailing Address - Fax:
Practice Address - Street 1:226 W ALMA AVE STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3520
Practice Address - Country:US
Practice Address - Phone:408-583-6338
Practice Address - Fax:408-516-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care