1669187795 NPI number — VALLEY-WIDE HEALTH SYSTEMS, INC.

Table of content: (NPI 1669187795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669187795 NPI number — VALLEY-WIDE HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY-WIDE HEALTH SYSTEMS, 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:
VALLEY-WIDE REGIONAL ASSESSMENT CENTER- LA JUNTA
Provider Other Organization Name Type Code:
3
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:
1669187795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOSA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81101-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-589-5161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 BARNES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JUNTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-511-5446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
719-587-1083

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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