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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | Maravich Enterprises dba Hidden Valley Pharmacy | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1790116861 · 1790806602 | [sources] | |||
| Registration number | PHY050997 · PHY51432 | [sources] | |||
| Sector | Entity/Corporation | [sources] | |||
| Address | 19851 Hartmann Rd., Unit C, Hidden Valley Lake, CA, 95467 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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| Linked to | ||||
|---|---|---|---|---|
| Object | Role | Start date | End date | |
| Hidden Valley Pharmacy Debarred entity | - | - | - | |