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NPI 1295724797

NPI 1295724797 : VALLEY-WIDE HEALTH SYSTEMS, INC : LA JARA, CO

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General NPI Number Information
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    NPI Number           |    1295724797
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    Entity Type          |    Organization 
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    Legal Business Name  |    VALLEY-WIDE HEALTH SYSTEMS, INC 
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Dates
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    Enumeration Date     |    10/18/2005
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    Last Update Date     |    05/10/2024
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Provider Practice Location Address
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    Address Line         |    421 WALNUT STREET 
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    City                 |    LA JARA
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    State                |    CO
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    Zip                  |    81140
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    Country              |    US
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    Telephone            |    719-274-8948
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    Fax                  |    719-274-8950
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Provider Business Mailing Address
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    Address Line         |    128 MARKET ST 
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    City                 |    ALAMOSA
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    State                |    CO
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    Zip                  |    81101-2290
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    Country              |    US
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    Telephone            |    719-587-1001
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    Fax                  |    
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Authorized Official
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    Title or Position    |    PRESIDENT/CEO
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    Name                 |     JANIA  ARNOLDI 
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    Credential           |    
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    Telephone            |    719-589-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    261QD0000X
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    Taxonomy Name        |    Dental Clinic/Center
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    License Number       |    
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    261QF0400X
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    Taxonomy Name        |    Federally Qualified Health Center (FQHC)
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    License Number       |    
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    License Number State |    CO
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