Healthcare Provider Details

I. General information

NPI: 1376489278
Provider Name (Legal Business Name): GOLDEN AGE CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 UPPER NEWPORT PLZ STE 207
NEWPORT BEACH CA
92660-2630
US

IV. Provider business mailing address

5 UPPER NEWPORT PLZ STE 207
NEWPORT BEACH CA
92660-2630
US

V. Phone/Fax

Practice location:
  • Phone: 949-630-0487
  • Fax: 877-497-3099
Mailing address:
  • Phone: 949-630-0487
  • Fax: 877-497-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MCKENZIE
Title or Position: MANAGING MEMBER
Credential:
Phone: 949-630-0487