Organization Name: | GOLDEN VALLEY HEALTH CENTER |
NPI Number: | 1508840562 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HELEN ROEHLK (CREDENTIALING SPECIALIST) |
Mailing Address: | 725 W I St Los Banos |
State: | CA US |
Postal Code: | 936353478 |
Phone Number: | 2098261094 |
Fax Number: | 2098267808 |
NPI Enumeration Date: | 12/02/2005 |
NPI Last Update Date: | 12/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 040000553 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |