Provider Demographics
NPI:1881798288
Name:GOLDEN VALLEY HEALTH CENTER
Entity type:Organization
Organization Name:GOLDEN VALLEY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-384-6493
Mailing Address - Street 1:737 WEST CHILDS AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-384-6493
Mailing Address - Fax:209-383-1296
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:209-556-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000303261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051089OtherMEDICARE NGS
CAZZZ50880ZOtherBLUE SHIELD OF CA
CACMM71154FMedicaid
CA051089OtherMEDICARE NGS