NPIMap

Organization Active NPI

Northeast Valley Health Corporation

Doing business as Transitions to Wellness-North Hollywood Health Center

  • Federally Qualified Health Center (FQHC)
  • North Hollywood, CA
National Provider Identifier
1902467574
Registry record updated Mar 3, 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-North Hollywood Health Center
Practice address
7843 Lankershim Blvd
North Hollywood, CA 91605-2523
Phone
(818) 485-5555
Fax
(818) 485-5556
NPI assigned
Jun 25, 2019
Last updated
Mar 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 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 Execuitve 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

7843 Lankershim Blvd
North Hollywood, CA 91605-2523

Mailing address

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

Other names 1

  • Transitions to Wellness-North Hollywood 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…
O20201203001108 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173517323 Practice locations: North Hollywood, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902467574. Details of each certification follow.

Federally qualified health center certification: CCN 921969

Legal name
NORTHEAST VALLEY HEALTH CORPORATION
Doing business as
TRANSITIONS TO WELLNESS NORTH HOLLYWOOD HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 15, 2020
Last certification
Oct 15, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 16, 1971 in CA
Enrollment address
7843 Lankershim Blvd
North Hollywood, CA 91605-2523

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
05D2168571Nevhc Transitions to Wellness-North7843 Lankershim Boulevard, North Hollywood, CA 91605Provider-performed microscopyJul 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Northeast Vall Ey28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

7843 Lankershim Blvd
North Hollywood, CA 91605
Phone (818) 765-8656

Ownership & related parties

All disclosed owners & managing parties 8

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 OfficerChief Financial Officer May 21, 1990
Kathryn Proctor Individual W-2 Managing EmployeeClinic Administrator Oct 19, 1993
Mark Stokes Individual Corporate OfficerSecretary of the Board of Direct Sep 8, 2015
Theresa Nitescu Individual Corporate OfficerChief Operations Officer Sep 15, 1995
Kurt Cabrera-Miller Individual Corporate OfficerVice Chairperson of the Board of Feb 25, 2013
Christine L Park Individual Corporate OfficerChief Medical Officer Jul 17, 2003
Juan Vargas Individual Corporate OfficerTreasurer Feb 29, 2016
Kimberly Wyard Individual Corporate OfficerChief Executive Officer Oct 17, 1974

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 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1902467574",
    "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": "7843 LANKERSHIM BLVD",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916052523",
            "telephone_number": "818-485-5555",
            "fax_number": "818-485-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST VALLEY HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "WYARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF EXECUITVE 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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Transitions to Wellness-North Hollywood Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Transitions to Wellness-North Hollywood Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Hollywood, CA

Sources for this page

Verify at the official NPI Registry.