Healthcare Provider Details

I. General information

NPI: 1962618538
Provider Name (Legal Business Name): GOLDEN ACRES ADULT DAY HEALTH CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12041 STRATHERN ST
NORTH HOLLYWOOD CA
91605-1415
US

IV. Provider business mailing address

12041 STRATHERN ST
NORTH HOLLYWOOD CA
91605-1415
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-1361
  • Fax: 818-767-1370
Mailing address:
  • Phone: 818-767-1361
  • Fax: 818-767-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SONNY AGBEDE
Title or Position: PRESIDENT
Credential:
Phone: 818-767-1361