Long Valley Health Center
Organization Active NPI Clinic/Center · Laytonville, CA
NPI 1366467375 · NPPES record last updated Nov 7, 2013
Key facts
- NPI
- 1366467375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- LONG VALLEY HEALTH CENTER
- Practice address
- 50 Branscomb Road
Laytonville, CA 95454 - Phone
- (707) 984-6131
- Fax
- (707) 984-6990
- NPI assigned
- Jul 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Rodney O Grainger
- Title
- Executive Director
- Phone
- (707) 984-6131
Practitioners 31
-
Cayo Kaweah Alba, CNM, PMHNP-BC
-
Janet Kay Byrd, FNP-C
-
Shaelah Ellen Lewis, FNP-C
-
Aliza Menashe, LCSW
-
Grace Marie Sakurada, MS, LMFT
-
Lynna R. Young, FNP-C
-
Maryn Lynna Young, FNP-BC, PMHNP-BC
-
Thomas A. Bertolli, M.D.
-
Tami Blecha, NP
-
Anuradha C Challa, M.D.,
-
Peter Young Cho, MD
-
Belinda Diane De Shay, PMHNP-BC
-
Carrie Alice Guilfoyle, ANP-C
-
Carla Price Longchamp, M.D.
-
Angela Rose Miller, D.O.
-
Laura Lynn Neimark-Gizara, MSW, LCSW
-
Cindy J Norvell, M.D.
-
Sharon Paltin, M.D.
-
Roshanda Grayson-Thomas, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0688924 | Long Valley Health Center | Provider-performed microscopy | Dec 11, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051933
- Legal name
- LONG VALLEY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 7, 1994
- Last certification
- Sep 7, 1994
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 11, 1978 in CA
- Enrollment address
- 50 Branscomb Rd
Laytonville, CA 95454-0870
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Natalie Klier |
Corporate Director |
Feb 27, 2017 | |
| Libbe Madsen |
Corporate Director |
Sep 20, 2010 | |
| Matthew O'Neill |
Corporate Director |
Jan 27, 2014 | |
| Dennis Hogan |
Corporate Director |
Jul 23, 2012 | |
| Elina Agnoli |
Corporate Director |
Dec 8, 2014 | |
| Kent Westwood |
Corporate Director |
Nov 22, 1999 | |
| Courtney Smith |
Corporate Director |
Nov 23, 2015 | |
| Roland Spence |
Corporate Director |
May 28, 2013 | |
| Elaine Carpenter |
Corporate Director |
Mar 24, 2014 | |
| Shantil Ferguson |
Corporate Director |
Aug 1, 2022 | 100% |
| W-2 Managing Employee |
Aug 1, 2022 | ||
| Maggie Carman |
W-2 Managing Employee |
May 4, 2020 | |
| Peter Steel |
Corporate Director |
Sep 20, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040302001373 | CA | Part B Supplier - Clinic/Group Practice | 8628965852 |
Receives reassigned benefits from 27 practitioners Practice locations: Laytonville, CA |
| O20101102001287 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 8628965852 | Practice locations: Laytonville, CA |
National Provider Directory
Locations
50 Branscomb Rd
Laytonville, CA 95454
Phone (707) 984-6131
51 Branscomb Rd
Laytonville, CA 95454
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AECBBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
50 Branscomb Road
Laytonville, CA 95454
Mailing address
PO Box 870
Laytonville, CA 95454-0870
Phone (707) 984-6131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC70034F | Medicaid | CA | |
| ZZZ84629Z | Other | NHIC |
Other providers in Laytonville, CA
- Judy Hansen
- Jane Keeley
- Gregory Kocher
- Shaelah Ellen Lewis
- Long Valley Fire Protection Dist
- Aliza Menashe
- Haley Megan Morse
- Candy Muzio
- Sharon Paltin
- Cecelia Pooleygillespie
All providers in Laytonville, CA · Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2013. 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.