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General NPI Number Information
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NPI Number | 1467171314
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Entity Type | Organization
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Legal Business Name | GOLDEN VALLEY HEALTH CENTER
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 1500 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4408
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Country | US
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Telephone | 866-682-4842
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Fax | 209-574-1372
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Provider Business Mailing Address
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Address Line | 737 W CHILDS AVE
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City | MERCED
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State | CA
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Zip | 95341-6805
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Country | US
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Telephone | 866-682-4842
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Fax | 209-359-2045
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TONY WEBER
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Credential |
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Telephone | 209-385-5462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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