NPIMap

Organization Active NPI

Long Valley Health Center

  • Clinic/Center
  • Laytonville, CA
National Provider Identifier
1366467375
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 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
Last updated
Nov 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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

Authorized official

Name
Rodney O Grainger
Title
Executive Director
Phone
(707) 984-6131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

50 Branscomb Road
Laytonville, CA 95454

Mailing address

PO Box 870
Laytonville, CA 95454-0870
Phone (707) 984-6131

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366467375. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Aug 11, 1978 in CA
Enrollment address
50 Branscomb Rd
Laytonville, CA 95454-0870

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
05D0688924Long Valley Health Center50 Branscomb Rd, Laytonville, CA 95454Provider-performed microscopyDec 11, 2026

National Provider Directory

National Provider Directory

Locations

51 Branscomb Rd
Laytonville, CA 95454

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AECBBA

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Natalie Klier Individual Corporate DirectorBoard Member Feb 27, 2017
Libbe Madsen Individual Corporate DirectorBoard Member Sep 20, 2010
Matthew O'Neill Individual Corporate DirectorBoard Member Jan 27, 2014
Dennis Hogan Individual Corporate DirectorBoard Member Jul 23, 2012
Elina Agnoli Individual Corporate DirectorBoard Member Dec 8, 2014
Kent Westwood Individual Corporate DirectorBoard Member Nov 22, 1999
Courtney Smith Individual Corporate DirectorBoard Member Nov 23, 2015
Roland Spence Individual Corporate DirectorBoard Member May 28, 2013
Elaine Carpenter Individual Corporate DirectorBoard Member Mar 24, 2014
Shantil Ferguson Individual Corporate DirectorInterim Executive Director Aug 1, 2022 100%
W-2 Managing EmployeeInterim Executive Director Aug 1, 2022
Maggie Carman Individual W-2 Managing EmployeeBilling Manager May 4, 2020
Peter Steel Individual Corporate DirectorBoard Member Sep 20, 2010

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383782400000",
    "number": "1366467375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870",
            "city": "LAYTONVILLE",
            "state": "CA",
            "postal_code": "954540870",
            "telephone_number": "707-984-6131",
            "fax_number": "707-984-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BRANSCOMB ROAD",
            "city": "LAYTONVILLE",
            "state": "CA",
            "postal_code": "95454",
            "telephone_number": "707-984-6131",
            "fax_number": "707-984-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2013-11-07",
        "status": "A",
        "authorized_official_last_name": "GRAINGER",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-984-6131"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laytonville, CA

Sources for this page

Verify at the official NPI Registry.