Provider Demographics
NPI:1437977527
Name:WEST VALLEY HEALTH EQUITY
Entity type:Organization
Organization Name:WEST VALLEY HEALTH EQUITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHARD-BUJAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-400-5881
Mailing Address - Street 1:4338 W THOMAS RD
Mailing Address - Street 2:ST 173
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031
Mailing Address - Country:US
Mailing Address - Phone:623-400-5881
Mailing Address - Fax:602-858-0309
Practice Address - Street 1:4338 W THOMAS RD
Practice Address - Street 2:ST 173
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031
Practice Address - Country:US
Practice Address - Phone:623-400-5881
Practice Address - Fax:602-858-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)