Healthcare Provider Details

I. General information

NPI: 1942719976
Provider Name (Legal Business Name): GOLDEN VALLEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 DELBON AVE
TURLOCK CA
95382-2021
US

IV. Provider business mailing address

1910 CUSTOMER CARE WAY
ATWATER CA
95301-5167
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-0905
  • Fax: 209-667-0922
Mailing address:
  • Phone: 209-384-6493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. TONY WEBER
Title or Position: CEO
Credential:
Phone: 209-385-5462