Provider Demographics
NPI:1447327804
Name:PAJARO VALLEY COMMUNITY HEALTH TRUST
Entity type:Organization
Organization Name:PAJARO VALLEY COMMUNITY HEALTH TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-726-4267
Mailing Address - Street 1:85 NIELSON ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2485
Mailing Address - Country:US
Mailing Address - Phone:831-726-4267
Mailing Address - Fax:831-722-2462
Practice Address - Street 1:85 NEILSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2485
Practice Address - Country:US
Practice Address - Phone:831-726-4267
Practice Address - Fax:831-722-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2513000000X251300000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherLICENSE NUMBER