NPIMap

Organization Active NPI

Northeast Valley Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Sun Valley, CA
National Provider Identifier
1013199264
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST VALLEY HEALTH CORPORATION
Practice address
7223 N. Fair Avenue
Sun Valley, CA 91352
Phone
(818) 432-4400
Fax
(818) 764-7930
NPI assigned
Nov 29, 2007
Last updated
Feb 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kimberly Wyard
Title
Chief Executive Officer
Phone
(818) 898-1388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7223 N. Fair Avenue
Sun Valley, CA 91352

Mailing address

1172 N Maclay Ave
San Fernando, CA 91340-1328
Phone (818) 898-1388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040412001067 CA Part B Supplier - Clinic/Group Practice 3173517323 Receives reassigned benefits from 235 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Van Nuys, CA; Valencia, CA; Sylmar, CA; Pacoima, CA; Sun Valley, CA; Santa Clarita, CA; San Fernando, CA; Canoga Park, CA…
O20080804000659 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173517323 Practice locations: Sun Valley, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013199264. Details of each certification follow.

Federally qualified health center certification: CCN 051137

Legal name
NORTHEAST VALLEY HEALTH CORPORATION
Doing business as
SUN VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 22, 2008
Last certification
Aug 22, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 16, 1971 in CA
Enrollment address
7223 Fair Ave
Sun Valley, CA 91352-4964

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1079632Northeast Valley Health Corporation7223 North Fair Avenue, Sun Valley, CA 91352Provider-performed microscopyFeb 3, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patricia Moraga Individual Corporate OfficerCfo May 21, 1990
Margarita Velasquez Individual W-2 Managing EmployeeClinic Administrator Jan 2, 2019
Mark Stokes Individual Corporate DirectorBoard Member Jan 1, 2026
Theresa Nitescu Individual Corporate OfficerCoo Sep 15, 1995
Kurt Cabrera-Miller Individual Corporate DirectorChairperson of the Board Feb 25, 2013
Christopher Reed Individual Corporate OfficerChief Executive Officer Aug 27, 2025
Christine L Park Individual Corporate OfficerChief Medical Officer Jul 17, 2003
Juan Vargas Individual Corporate DirectorBoard Member Jan 1, 2026
Theodore Bradpiece Individual Corporate DirectorVice Chairperson of the Board Aug 30, 2010

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1013199264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 N MACLAY AVE",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913401328",
            "telephone_number": "818-898-1388",
            "fax_number": "818-365-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7223 N. FAIR AVENUE",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "91352",
            "telephone_number": "818-432-4400",
            "fax_number": "818-764-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST VALLEY HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "WYARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-898-1388",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun Valley, CA

Sources for this page

Verify at the official NPI Registry.