Healthcare Provider Details

I. General information

NPI: 1215140843
Provider Name (Legal Business Name): GOLDEN STATE ADULT DAY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

738 LA PLAYA ST
SAN FRANCISCO CA
94121-3262
US

IV. Provider business mailing address

738 LA PLAYA ST
SAN FRANCISCO CA
94121-3262
US

V. Phone/Fax

Practice location:
  • Phone: 451-387-2750
  • Fax: 415-387-2712
Mailing address:
  • Phone: 451-387-2750
  • Fax: 415-387-2712

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: DR. DMITRY MARGUSOV
Title or Position: ADMINISTRATOR
Credential: D.C.
Phone: 415-387-2750