Basic Information
| Provider Information | |||||||||
| NPI: | 1629570320 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNTAIN VALLEYS HEALTH CENTERS | ||||||||
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| OtherOrganizationName: | MOUNTAIN VALLEYS HEALTH CENTERS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277 | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302945375 | ||||||||
| FaxNumber: | 5302945801 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 OLD MCCLOUD RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT SHASTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960672796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309265100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2018 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | DAVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5302945241 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.