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General NPI Number Information
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NPI Number | 1427209048
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE SENIOR LIVING INC.
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 218 CHANNING WAY
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City | ALAMEDA
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State | CA
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Zip | 94502-6452
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Country | US
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Telephone | 510-522-3812
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Fax | 510-903-1312
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Provider Business Mailing Address
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Address Line | 230 SWEET RD
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City | ALAMEDA
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State | CA
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Zip | 94502-7798
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Country | US
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Telephone | 510-522-3812
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Fax | 510-903-1312
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARICEL TINIO
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Credential |
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Telephone | 510-522-3812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 015600840
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 015600840
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License Number State | CA
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