MEDICARE: GOLDEN HORIZON SENIOR CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1043956485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN HORIZON SENIOR CARE LLC

Provider Business Mailing Address
First Line	:	7159 HAZELWOOD WAY
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-1659
Country	:	US
Telephone Number	:	786-564-3771
Fax Number	:	909-408-8027

Provider Business Practice Location Address
First Line	:	1524 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-5821
Country	:	US
Telephone Number	:	786-564-3771
Fax Number	:	909-408-8027

Authorized Official
Title or Position	:	OWNER
Name	:	EBRAHEEM H HAMED
Credential	:
Telephone Number	:	786-564-3771

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/09/2022

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