1962558239 NPI number — SILVER AGE HOME HEALTH CARE AGENCY, INC.

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 1962558239 NPI number — SILVER AGE HOME HEALTH CARE AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER AGE HOME HEALTH CARE AGENCY, 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:
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:
1962558239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/22/2023
NPI Reactivation Date:
08/09/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S LA FAYETTE PARK PL STE 100-B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-5402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-385-5788
Provider Business Mailing Address Fax Number:
213-385-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S LA FAYETTE PARK PL STE 100-B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-5402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-5788
Provider Business Practice Location Address Fax Number:
213-385-5850
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRINIDAD
Authorized Official First Name:
ANGELITO
Authorized Official Middle Name:
DOMINGO
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
213-385-5788

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  550000242 , 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)





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