Healthcare Provider Details

I. General information

NPI: 1427209048
Provider Name (Legal Business Name): GOLDEN AGE SENIOR LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 CHANNING WAY
ALAMEDA CA
94502-6452
US

IV. Provider business mailing address

230 SWEET RD
ALAMEDA CA
94502-7798
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-3812
  • Fax: 510-903-1312
Mailing address:
  • Phone: 510-522-3812
  • Fax: 510-903-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number015600840
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number015600840
License Number StateCA

VIII. Authorized Official

Name: MARICEL TINIO
Title or Position: ADMINISTRATOR
Credential:
Phone: 510-522-3812