Healthcare Provider Details

I. General information

NPI: 1932658010
Provider Name (Legal Business Name): GOLDEN STATE HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 N NORMANDIE AVE
LOS ANGELES CA
90027-5817
US

IV. Provider business mailing address

1409 N NORMANDIE AVE
LOS ANGELES CA
90027-5817
US

V. Phone/Fax

Practice location:
  • Phone: 818-731-1199
  • Fax:
Mailing address:
  • Phone: 818-731-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: METKSYA DIREMSIZYAN
Title or Position: CEO
Credential:
Phone: 818-731-1199