MEDICARE: GOLDEN VALLEY HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	040000180	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	040000180	OTHER	CA	STATE OF CA LIC#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ZZZ73071Z	OTHER	CA	BLUE SHIELD OF CA GRP PIN

General Provider Information

NPI Number	:	1255339644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN VALLEY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	1910 CUSTOMER CARE WAY
Second Line	:
City	:	ATWATER
State	:	CA
Zip	:	95301-5167
Country	:	US
Telephone Number	:	209-722-4842
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 W CHILDS AVE
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95341-6862
Country	:	US
Telephone Number	:	209-383-7441
Fax Number	:	209-383-0318

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DAVID QUACKENBUSH
Credential	:
Telephone Number	:	209-913-2261

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/14/2025

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Directions to “GOLDEN VALLEY HEALTH CENTERS ” Practice Location

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