Healthcare Provider Details

I. General information

NPI: 1316698954
Provider Name (Legal Business Name): GOLDEN MEMORIES ADHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 SOUTH ST
LAKEWOOD CA
90713-1713
US

IV. Provider business mailing address

19231 VICTORY BLVD STE 200
RESEDA CA
91335-6330
US

V. Phone/Fax

Practice location:
  • Phone: 818-747-3777
  • Fax:
Mailing address:
  • Phone: 818-747-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NORAYR HOVHANNISYAN
Title or Position: MANAGER
Credential:
Phone: 818-747-3777