=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255140323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN AGE ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2025
-----------------------------------------------------
Last Update Date | 01/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 PARKWAY PLZ
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92020-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-401-2040
-----------------------------------------------------
Fax | 619-201-8470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 PARKWAY PLZ
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92020-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-401-2040
-----------------------------------------------------
Fax | 619-201-8470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SOHEILA VAKILI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-401-2040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------