Organization
GOLDEN VALLEY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY WEBER (CEO)
(209) 384-6493
Entity
Organization
Contact information
Practice address
1510 FLORIDA AVE, SUITE H, MODESTO, CA 95350-4437
(209) 574-1030
(209) 574-1038
Mailing address
737 W CHILDS AVE, MERCED, CA 95340-6805
(209) 384-6493
(209) 383-1296
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
030000554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030000554
STATE OF CA LIC#
CA
01
—
CMM70634F
CMM#
CA
01
—
FHC70634F
FQHC#
CA
05
—
GR008628A
—
CA
01
—
ZZZ52118Z
BLUE SHIELD OF CA GRP PIN
CA
Enumeration date
12/06/2005
Last updated
02/09/2017
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