Healthcare Provider Details

I. General information

NPI: 1467436048
Provider Name (Legal Business Name): GOLDEN VALLEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 FLORIDA AVE SUITE F
MODESTO CA
95350-4437
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95340-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-549-7090
  • Fax: 209-549-7099
Mailing address:
  • Phone: 209-383-1848
  • Fax: 209-383-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number030000554
License Number StateCA

VIII. Authorized Official

Name: HELEN ROEHLK
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 209-385-5434