1619033826 NPI number — LIFE'S GOLDEN HORIZONS, INC

Table of content: (NPI 1619033826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619033826 NPI number — LIFE'S GOLDEN HORIZONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE'S GOLDEN HORIZONS, INC
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:
6
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:
1619033826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42212 10TH ST W STE 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-949-6278
Provider Business Mailing Address Fax Number:
661-949-6768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44902 10TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-6278
Provider Business Practice Location Address Fax Number:
661-949-6768
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIRO
Authorized Official First Name:
YOUNG
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
661-949-6278

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  060000760 , 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: ADU70204G . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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