NPIMap

Organization Active NPI

Northeast Valley Health Corporation

Doing business as Transitions to Wellness-Van Nuys Health Center

  • Federally Qualified Health Center (FQHC)
  • Van Nuys, CA
National Provider Identifier
1184625568
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
Doing business as
Transitions to Wellness-Van Nuys Health Center
Practice address
6551 Van Nuys Blvd FL 2
Van Nuys, CA 91401-1566
Phone
(818) 765-8656
Fax
(818) 765-6982
NPI assigned
Aug 9, 2005
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
Mrs. Kimberly Wyard
Title
Chief Executive Officer
Phone
(818) 898-1388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

6551 Van Nuys Blvd FL 2
Van Nuys, CA 91401-1566

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
05-1086OtherCAMEDICARE PART A
FHC70582FOtherCAMEDI-CAL
CB204579OtherCAMEDICARE PART B
W14819DOtherMIN

Other names 1

  • Transitions to Wellness-Van Nuys Health Center Doing business as

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…
O20220104002795 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173517323 Practice locations: Van Nuys, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184625568. Details of each certification follow.

Federally qualified health center certification: CCN A01070

Legal name
NORTHEAST VALLEY HEALTH CORPORATION
Doing business as
TRANSITIONS TO WELLNESS - VAN NUYS HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 2, 2022
Last certification
Feb 2, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 16, 1971 in CA
Enrollment address
6551 Van Nuys Blvd
Ste 201
Van Nuys, CA 91401-1490

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

National Provider Directory

National Provider Directory

Locations

14624 Sherman Way
Ste 600
Van Nuys, CA 91405
Phone (818) 787-9909

Ownership & related parties

All disclosed owners & managing parties 18

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
Kathryn Proctor Individual W-2 Managing EmployeeClinical Administrator Dec 22, 2021
Mark Stokes Individual Corporate DirectorBoard Member Sep 8, 2015
Michael Cousineau Individual Corporate DirectorBoard Member Mar 28, 2016
Mashica Winslow Individual Corporate DirectorBoard Member Sep 23, 2021
Cynthia Guerrero Individual Corporate DirectorBoard Member Nov 29, 2019
Theresa Nitescu Individual Corporate OfficerCoo Sep 15, 1995
Maria a Pacheco Individual Corporate DirectorBoard Member Mar 31, 2014
Richard Galvan Individual Corporate DirectorBoard Member Feb 25, 2019
Sonia Mariscal-Navarro Individual Corporate DirectorBoard Member Jun 27, 2016
Diane Morey Individual Corporate DirectorBoard Member Apr 27, 2020
Kurt Cabrera-Miller Individual Corporate DirectorBoard Member Feb 25, 2013
Darlene Bragg Individual Corporate DirectorBoard Member Jun 24, 2018
Juan Vargas Individual Corporate DirectorBoard Member Feb 29, 2016
Theodore Bradpiece Individual Corporate DirectorBoard Member Mar 31, 2009
Kimberly Wyard Individual Corporate OfficerCeo Oct 17, 1974
Paul J Chung Individual Corporate DirectorBoard Member Jul 26, 2016
Cittlaly Vasquez Individual Corporate DirectorBoard Member Sep 26, 2016

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1184625568",
    "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": "818-270-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6551 VAN NUYS BLVD FL 2",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914011566",
            "telephone_number": "818-765-8656",
            "fax_number": "818-765-6982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST VALLEY HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "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": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "05-1086",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "FHC70582F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "CB204579",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIN",
            "identifier": "W14819D",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Transitions to Wellness-Van Nuys Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.