NPIMap

Organization Active NPI

Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
National Provider Identifier
1205810389
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
030000519 Issued in CA
Legal business name
GOLDEN VALLEY HEALTH CENTER
Practice address
1121 Hammond St
Modesto, CA 95351-3509
Phone
(209) 576-4437
Fax
(209) 576-4494
NPI assigned
Dec 2, 2005
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Quackenbush
Title
Ceo and President
Phone
(209) 913-2261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 030000519 CA Primary

Addresses

Primary practice location

1121 Hammond St
Modesto, CA 95351-3509

Mailing address

1910 Customer Care Way
Atwater, CA 95301-5167
Phone (209) 722-4842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000641 CA Part B Supplier - Clinic/Group Practice 4183527187 Receives reassigned benefits from 494 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA; Manteca, CA; Newman, CA; Patterson, CA; Planada, CA; Riverbank, CA; Turlock, CA; Westley, CA…
O20111220000858 CA Part A Provider - Federally Qualified Health Center (FQHC) 4183527187 Practice locations: Modesto, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205810389. Details of each certification follow.

Federally qualified health center certification: CCN 051036

Legal name
GOLDEN VALLEY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 13, 2005
Last certification
Dec 13, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1974 in CA
Enrollment address
1121 Hammond St
Modesto, CA 95351-3509

Other NPIs on the same Medicare enrollment 45

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 45

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gurjeet Sandhu Individual Corporate OfficerVP and Chief Financial Officer Jun 23, 2003
W-2 Managing EmployeeVP and Chief Financial Officer Jun 23, 2003
Robert Bernard Anderson Individual Corporate DirectorBoard Member Mar 1, 2016
David Ray Carr Individual Corporate DirectorBoard Member Sep 8, 2022
David Quackenbush Individual Corporate OfficerPresident and Ceo May 1, 2024
Corporate DirectorPresident and Ceo May 1, 2024
Operational/Managerial ControlPresident and Ceo May 1, 2024
Keshava David Kamins Individual Corporate DirectorBoard Member Mar 9, 2023
Tamara Ramaine Cobb Individual Corporate DirectorBoard Member Oct 11, 2018
Ernesto Martin Gomez Individual Corporate DirectorBoard Member Feb 1, 2016
Tricia Forshey Individual W-2 Managing EmployeeSenior Credentialing Specialist Apr 26, 2021
Maria Rafela Vargas-Perez Individual Corporate DirectorConsumer, Board Member Sep 9, 2011 8%
John Edward Price Individual Corporate DirectorTreasurer, Board Member Jul 1, 1986 8%
Maria Rosales Individual Corporate DirectorBoard Member Aug 13, 2015

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1205810389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 CUSTOMER CARE WAY",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953015167",
            "telephone_number": "209-722-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 HAMMOND ST",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953513509",
            "telephone_number": "209-576-4437",
            "fax_number": "209-576-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "QUACKENBUSH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "209-913-2261"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "030000519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.