Healthcare Provider Details

I. General information

NPI: 1619033826
Provider Name (Legal Business Name): LIFE'S GOLDEN HORIZONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44902 10TH ST W
LANCASTER CA
93534-2314
US

IV. Provider business mailing address

42212 10TH ST W STE 8
LANCASTER CA
93534-7005
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-6278
  • Fax: 661-949-6768
Mailing address:
  • Phone: 661-949-6278
  • Fax: 661-949-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000760
License Number StateCA

VIII. Authorized Official

Name: MR. YOUNG HIRO
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-949-6278