Healthcare Provider Details

I. General information

NPI: 1902977218
Provider Name (Legal Business Name): GOLDEN AGE ADULT DAY HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18332 VENTURA BLVD
TARZANA CA
91356-4219
US

IV. Provider business mailing address

18332 VENTURA BLVD
TARZANA CA
91356-4219
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-9393
  • Fax:
Mailing address:
  • Phone: 818-345-9393
  • Fax:

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: KATHY BAKSHIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-345-9393