Healthcare Provider Details

I. General information

NPI: 1225140098
Provider Name (Legal Business Name): GOLDEN HEART HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 OCEAN VIEW BLVD SUITE 1
GLENDALE CA
91208-3409
US

IV. Provider business mailing address

3539 OCEAN VIEW BLVD SUITE 1
GLENDALE CA
91208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 818-957-0009
  • Fax: 818-957-0004
Mailing address:
  • Phone: 818-957-0009
  • Fax: 818-957-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980001505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D1010294
License Number StateCA

VIII. Authorized Official

Name: MRS. DIANA KAZARYAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 818-957-0009