Healthcare Provider Details

I. General information

NPI: 1346098621
Provider Name (Legal Business Name): GOLDEN AGE ADHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N MCKINLEY ST
CORONA CA
92879-6566
US

IV. Provider business mailing address

135 N MCKINLEY ST
CORONA CA
92879-6566
US

V. Phone/Fax

Practice location:
  • Phone: 951-808-9600
  • Fax:
Mailing address:
  • Phone: 951-808-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: VIPUL KORAT
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-808-9600