Basic Information
| Provider Information | |||||||||
| NPI: | 1124204292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDEN VALLEY HEALTH CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2760 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CERES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953073220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095565011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2760 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CERES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953073220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095565011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2008 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROEHLK | ||||||||
| AuthorizedOfficialFirstName: | HELEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADM. ASSIST. CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 2093855434 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GOLDEN VALLEY HEALTH CENTERS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.