MEDICARE: GOLDEN GROVE HOME CARE INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568159879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN GROVE HOME CARE INC.

Provider Business Mailing Address
First Line	:	15545 DEVONSHIRE ST STE 100C
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2667
Country	:	US
Telephone Number	:	818-810-0211
Fax Number	:	818-600-9169

Provider Business Practice Location Address
First Line	:	15545 DEVONSHIRE ST STE 100C
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2667
Country	:	US
Telephone Number	:	818-810-0211
Fax Number	:	818-600-9169

Authorized Official
Title or Position	:	CEO/CFO/SECRETARY
Name	:	MRS. NAZIG NAHABED SISAKIAN
Credential	:
Telephone Number	:	818-810-0211

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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