Healthcare Provider Details

I. General information

NPI: 1295366177
Provider Name (Legal Business Name): VALLEY-WIDE HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 BARNES
LA JUNTA CO
81050
US

IV. Provider business mailing address

128 MARKET ST
ALAMOSA CO
81101-2290
US

V. Phone/Fax

Practice location:
  • Phone: 719-384-5446
  • Fax:
Mailing address:
  • Phone: 719-587-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAVIER MARTINEZ
Title or Position: CFO
Credential:
Phone: 719-587-1083