1386775237 NPI number — SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386775237 NPI number — SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386775237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16360 ROSCOE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91406-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-901-4830
Provider Business Mailing Address Fax Number:
818-785-3446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-901-4879
Provider Business Practice Location Address Fax Number:
818-997-1370
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RYDER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-901-4830

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  D0591483 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000007622 . This is a "MEDICAL PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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