MEDICARE: NORTHRIDGE GOLDEN NEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	197605610	CA
2	310400000X	Assisted Living Facility	197604051	CA

General Provider Information

NPI Number	:	1033353701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHRIDGE GOLDEN NEST

Provider Business Mailing Address
First Line	:	9314 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-2744
Country	:	US
Telephone Number	:	818-472-2366
Fax Number	:	818-886-1230

Provider Business Practice Location Address
First Line	:	9314 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-2744
Country	:	US
Telephone Number	:	818-472-2366
Fax Number	:	818-886-1230

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GALIT PELED
Credential	:
Telephone Number	:	818-472-2366

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	04/27/2009

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Directions to “NORTHRIDGE GOLDEN NEST ” Practice Location

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