Healthcare Provider Details

I. General information

NPI: 1366467375
Provider Name (Legal Business Name): LONG VALLEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BRANSCOMB ROAD
LAYTONVILLE CA
95454
US

IV. Provider business mailing address

PO BOX 870
LAYTONVILLE CA
95454-0870
US

V. Phone/Fax

Practice location:
  • Phone: 707-984-6131
  • Fax: 707-984-6990
Mailing address:
  • Phone: 707-984-6131
  • Fax: 707-984-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RODNEY O GRAINGER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-984-6131