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General NPI Number Information
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NPI Number | 1568939205
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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 | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 209 KERR AVE
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City | MODESTO
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State | CA
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Zip | 95354-3808
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Country | US
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Telephone | 209-576-6766
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Fax | 209-576-6770
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Provider Business Mailing Address
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Address Line | 1910 CUSTOMER CARE WAY
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City | ATWATER
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State | CA
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Zip | 95301-5167
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Country | US
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Telephone | 209-383-1848
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Fax | 855-202-9336
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Authorized Official
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Title or Position | CEO
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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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