1851571673 NPI number — GOLDEN SENIOR CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851571673 NPI number — GOLDEN SENIOR CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN SENIOR CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851571673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16317 SANTA BIANCA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACIENDA HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91745-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-217-7278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1946 ATLANTIDA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-217-7278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAPA
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
VIRATA
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
626-217-7278

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RCF00036F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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