Healthcare Provider Details

I. General information

NPI: 1285545723
Provider Name (Legal Business Name): GOLDEN GROVE CARE ONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12256 HAGA ST
GARDEN GROVE CA
92841-3227
US

IV. Provider business mailing address

12256 HAGA ST
GARDEN GROVE CA
92841-3227
US

V. Phone/Fax

Practice location:
  • Phone: 949-994-2900
  • Fax: 714-333-4412
Mailing address:
  • Phone: 949-994-2900
  • Fax: 714-333-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AHMED ATTRAH
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-994-2900