Healthcare Provider Details

I. General information

NPI: 1114434552
Provider Name (Legal Business Name): GOLDEN VALLEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 W MONTE VISTA AVE
TURLOCK CA
95382-9667
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-1270
  • Fax: 209-667-1269
Mailing address:
  • Phone: 209-384-6493
  • Fax: 855-202-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. GENEVIEVE MEDINA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 209-384-6493