=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790331817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY HEALTHCARE CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2019
-----------------------------------------------------
Last Update Date | 08/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 252 N HIGHWAY 65
-----------------------------------------------------
City | LINDSAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93247-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-781-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 W PUTNAM AVE STE 11
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-781-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JOHN ANGELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-306-1352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------