Healthcare Provider Details

I. General information

NPI: 1558196394
Provider Name (Legal Business Name): VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COMMUNITY DR STE 202
TOBYHANNA PA
18466-8987
US

IV. Provider business mailing address

PO BOX 780631
PHILADELPHIA PA
19178-0631
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-3585
  • Fax: 570-421-9014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
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: VERONICA GONZALEZ
Title or Position: CEO
Credential:
Phone: 610-969-2728