Provider Demographics
NPI:1093817405
Name:GOLDEN VALLEY HEALTH CENTERS
Entity Type:Organization
Organization Name:GOLDEN VALLEY HEALTH CENTERS
Other - Org Name:GVHC MERCED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:GURJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-384-6516
Mailing Address - Street 1:857 W CHILDS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6862
Mailing Address - Country:US
Mailing Address - Phone:209-384-6516
Mailing Address - Fax:714-599-8242
Practice Address - Street 1:857 W CHILDS AVE STE 101
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6862
Practice Address - Country:US
Practice Address - Phone:209-384-6516
Practice Address - Fax:209-383-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHY432163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093817405Medicaid
2164153OtherPK