=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255339644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN VALLEY HEALTH CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 847 W CHILDS AVE
-----------------------------------------------------
City | MERCED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95341-6862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-383-7441
-----------------------------------------------------
Fax | 209-383-0318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1910 CUSTOMER CARE WAY
-----------------------------------------------------
City | ATWATER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95301-5167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-722-4842
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | DAVID QUACKENBUSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-913-2261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | 040000180
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------