=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790652519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH VALLEY HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4820 HARWOOD RD STE 110
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95124-5276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-357-9801
-----------------------------------------------------
Fax | 408-357-9805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4820 HARWOOD RD STE 110
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95124-5276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-357-9801
-----------------------------------------------------
Fax | 408-357-9805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | JESSE DEWITT BALLARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-299-4457
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------