- Enrollment id
- O20241028000667
- Enrollment state
- CA
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1144075029
- Multiple npi flag
- N
- Ccn
- A01892
- Associate id
- 4183527187
- Organization name
- GOLDEN VALLEY HEALTH CENTERS
- Incorporation date
- 2024-05-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 1524 MCHENRY AVE
- Address line 2
- STE 330
- City
- MODESTO
- State
- CA
- Zip code
- 953504567
- Telephone number
- 2097224842