Healthcare Provider Details

I. General information

NPI: 1801749668
Provider Name (Legal Business Name): GOLDEN LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SW APPLE WAY
PORTLAND OR
97225-1772
US

IV. Provider business mailing address

13435 SW HAWKS BEARD ST APT 822
TIGARD OR
97223-2127
US

V. Phone/Fax

Practice location:
  • Phone: 503-860-5566
  • Fax:
Mailing address:
  • Phone: 503-860-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTORIA GUSENKOV
Title or Position: MANAGER
Credential:
Phone: 503-860-5566