Healthcare Provider Details

I. General information

NPI: 1629579354
Provider Name (Legal Business Name): GOLDEN LIVING IN SYLMAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14060 ASTORIA ST
SYLMAR CA
91342-2949
US

IV. Provider business mailing address

14060 ASTORIA ST
SYLMAR CA
91342-2949
US

V. Phone/Fax

Practice location:
  • Phone: 818-642-3668
  • Fax: 818-864-6820
Mailing address:
  • Phone: 818-642-3668
  • Fax: 818-864-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MARILYN VAN NGUYEN
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 818-642-3668