Healthcare Provider Details

I. General information

NPI: 1235946336
Provider Name (Legal Business Name): TRI VALLEY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 NORTH NAGLEE ROAD SUITE 100 #1037
TRACY CA
95304
US

IV. Provider business mailing address

2471 NORTH NAGLEE ROAD SUITE 100 #1037
TRACY CA
95304
US

V. Phone/Fax

Practice location:
  • Phone: 510-755-3004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY OGBODO
Title or Position: PRESIDENT
Credential:
Phone: 510-755-3004