Organization
GOLDEN VALLEY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY WEBER (CEO)
(209) 384-6493
Entity
Organization
Contact information
Practice address
1130 6TH ST, MODESTO, CA 95354-2203
(209) 491-5550
(209) 491-5468
Mailing address
737 W CHILDS AVE, MERCED, CA 95341-6805
(209) 384-6493
(209) 383-1296
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
030000757
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030000757
STATE OF CA LIC#
CA
05
—
CMM70889F
—
CA
Enumeration date
12/06/2005
Last updated
02/09/2017
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