Healthcare Provider Details

I. General information

NPI: 1538034764
Provider Name (Legal Business Name): VALLEY BRIDGE RESOURCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 S 4TH ST STE B
EL CENTRO CA
92243-4560
US

IV. Provider business mailing address

12541 JOLETTE AVE
GRANADA HILLS CA
91344-1661
US

V. Phone/Fax

Practice location:
  • Phone: 818-807-0530
  • Fax:
Mailing address:
  • Phone: 818-807-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KHRIST KAKOSIMIDI
Title or Position: CEO
Credential:
Phone: 818-807-0530