Healthcare Provider Details

I. General information

NPI: 1730228867
Provider Name (Legal Business Name): GOLDEN AGE CONVALESCENT HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 BURLINGAME AVE
CAPITOLA CA
95010-3307
US

IV. Provider business mailing address

523 BURLINGAME AVE
CAPITOLA CA
95010-3307
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-0722
  • Fax: 831-475-1048
Mailing address:
  • Phone: 831-475-0722
  • Fax: 831-475-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MISS ESTERLITA CORTES TAPANG
Title or Position: PRESIDENT
Credential:
Phone: 408-761-7000