Provider Demographics
NPI:1124204292
Name:GOLDEN VALLEY HEALTH CENTERS
Entity Type:Organization
Organization Name:GOLDEN VALLEY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. ASSIST. CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-385-5434
Mailing Address - Street 1:2760 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3220
Mailing Address - Country:US
Mailing Address - Phone:209-556-5011
Mailing Address - Fax:
Practice Address - Street 1:2760 3RD ST
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3220
Practice Address - Country:US
Practice Address - Phone:209-556-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN VALLEY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)