| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 121 Downey Ave, Modesto, California |
| Authorized Official Name and Position | Leslie Davis (SVP, CFO) |
| Authorized Official Contact | 5103377950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1080 Marina Village Pkwy Suite 100 Alameda CA 94501-6427 Ph: (510) 337-7950 | 121 Downey Ave Modesto CA 95354 Ph: (209) 341-1824 |
| NPI Number | 1356427413 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 07/07/2021 |
| Certification Date | 07/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356427413 | NPI | - | NPPES |
| CR722J | Other | CA | MEDICARE PTAN |
| 5077 | Other | CA | COUNTY MENTAL HEALTH CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Golden Valley Health Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1130 6th St, Modesto, CA 95354 Phone: 209-576-2845 Fax: 209-384-3966 | |
Golden Valley Health Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1717 Las Vegas St, Modesto, CA 95358 Phone: 209-576-4200 Fax: 209-384-3966 | |