Organization
GOLDEN VALLEY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID QUACKENBUSH (CEO AND PRESIDENT)
(209) 913-2261
Entity
Organization
Contact information
Practice address
821 TEXAS AVE, LOS BANOS, CA 93635-3453
(209) 826-1045
(209) 826-0952
Mailing address
1910 CUSTOMER CARE WAY, ATWATER, CA 95301-5167
(209) 722-4842
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
040000215
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040000215
STATE OF CA LIC#
CA
05
—
CMM03901F
—
CA
05
—
GR0086288
—
CA
01
—
ZZZ83386Z
BLUE SHIELD OF CA GRP PIN
CA
Enumeration date
12/02/2005
Last updated
02/26/2026
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