Healthcare Provider Details

I. General information

NPI: 1598302655
Provider Name (Legal Business Name): GOLDEN VALLEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ORANGEBURG AVE STE 330
MODESTO CA
95355-3396
US

IV. Provider business mailing address

2401 E ORANGEBURG AVE STE 330
MODESTO CA
95355-3396
US

V. Phone/Fax

Practice location:
  • Phone: 209-724-6000
  • Fax:
Mailing address:
  • Phone: 209-724-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON WEST
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 209-724-6000