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General NPI Number Information
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NPI Number | 1235680414
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Entity Type | Organization
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Legal Business Name | GOLDEN DIAMOND RETIREMENT, LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 8792 CERRITOS AVE
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City | ANAHEIM
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State | CA
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Zip | 92804-5780
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Country | US
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Telephone | 657-256-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 8792 CERRITOS AVE
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City | ANAHEIM
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State | CA
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Zip | 92804-5780
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Country | US
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Telephone | 657-256-1062
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Fax |
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Authorized Official
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Title or Position | CEO / ADMINISTRATOR
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Name | KEVIN NGUYEN
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Credential |
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Telephone | 714-661-4685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 306004804
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License Number State | CA
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