- Enrollment id
- O20210428000143
- Enrollment state
- CA
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1508464116
- Multiple npi flag
- N
- Ccn
- A01025
- Associate id
- 4183527187
- Organization name
- GOLDEN VALLEY HEALTH CENTERS
- Incorporation date
- 1972-11-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 1524 MCHENRY AVE
- Address line 2
- STE 560
- City
- MODESTO
- State
- CA
- Zip code
- 953504573
- Telephone number
- 2097224842