MEDICARE: GOLDEN YEARS BOARDING CARE INC.

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	:	1093672149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS BOARDING CARE INC.

Provider Business Mailing Address
First Line	:	7820 FULTON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 FULTON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1810
Country	:	US
Telephone Number	:	916-596-5652
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	VAHE HOVHAN
Credential	:
Telephone Number	:	916-596-5652

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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