Healthcare Provider Details

I. General information

NPI: 1720839673
Provider Name (Legal Business Name): MOUNTAIN VALLEYS HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 3RD ST
DORRIS CA
96023-9100
US

IV. Provider business mailing address

PO BOX 277
BIEBER CA
96009-0277
US

V. Phone/Fax

Practice location:
  • Phone: 530-999-9070
  • Fax:
Mailing address:
  • Phone: 530-999-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WATKINS
Title or Position: CFO
Credential:
Phone: 530-249-6857