Northeast Valley Health Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Sun Valley, CA
NPI 1013199264 · NPPES record last updated Feb 22, 2022
Key facts
- NPI
- 1013199264
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Ms. Kimberly Wyard
- Title
- Chief Executive Officer
- Phone
- (818) 898-1388
Owners & managing parties with NPI records 2
-
Christine Lim-Fun Chan Park, M.D., MPH
-
Juan Vargas, MD
Other NPIs on the same Medicare enrollment 16
Other NPIs with the same Medicare PAC ID 13
Practitioners 91
-
Roselyn M Dinsay, MD
-
Jennifer McLean-Madera, NP,PHN,RN
-
Mark S Fan, MD
-
Irfan Ahsan, DPM
-
Azizeh Asgari, M.D.
-
Nancy Avendano, FNP
-
Latonya Burnell, N.P.
-
Karin Yepremian Butcher, M.D.
-
Yvette Santana Cardenas, LCSW
-
David Chen, DO
-
Rohit Chetty, MD
-
Cory Clement, D.P.M.
-
Brian Raye Collins, M.D.
-
Victoria Curtin, LCSW
-
Catherine Cusi, NP
-
Tina Donaldson, RN, NP
-
Michele Lynn Eno, M.D.
-
Michaela Nicole Fajardo, PA-C
-
Nancy Elizabeth Fitts, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1079632 | Northeast Valley Health Corporation | Provider-performed microscopy | Feb 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
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
- Corporation · Non-profit
- Incorporated
- Feb 16, 1971 in CA
- Enrollment address
- 7223 Fair Ave
Sun Valley, CA 91352-4964
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia Moraga |
Corporate Officer |
May 21, 1990 | |
| Margarita Velasquez |
W-2 Managing Employee |
Jan 2, 2019 | |
| Mark Stokes |
Corporate Director |
Jan 1, 2026 | |
| Theresa Nitescu |
Corporate Officer |
Sep 15, 1995 | |
| Kurt Cabrera-Miller |
Corporate Director |
Feb 25, 2013 | |
| Christopher Reed |
Corporate Officer |
Aug 27, 2025 | |
| Christine L Park |
Corporate Officer |
Jul 17, 2003 | |
| Juan Vargas |
Corporate Director |
Jan 1, 2026 | |
| Theodore Bradpiece |
Corporate Director |
Aug 30, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05-1137 | Other | CA | MEDICARE PROVIDER # |
Other providers in Sun Valley, CA
- New Reach Hospice Care
- Nextgen Diagnostics Inc
- Nisha Kripalani, D.D.S., Inc.
- Normandie Home Health LLC
- Normandie Home Health, Inc
- Hamid Nouri
- Novacore Diagnostics Inc
- NP Home Services, LLC.
- NPK Pharmaceutical Inc
- NPK Pharmaceutical Inc
All providers in Sun Valley, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.