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NPI Code Detail

MEDICARE: GOLDEN STATE ADULT DAY HEALTH CARE INC

MEDICARE: GOLDEN STATE ADULT DAY HEALTH 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
1261QA0600XAdult Day Care Clinic/CenterCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215140843
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDEN STATE ADULT DAY HEALTH CARE INC
Provider Business Mailing Address
First Line : 738 LA PLAYA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94121-3262
Country : US
Telephone Number : 451-387-2750
Fax Number : 415-387-2712
Provider Business Practice Location Address
First Line : 738 LA PLAYA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94121-3262
Country : US
Telephone Number : 451-387-2750
Fax Number : 415-387-2712
Authorized Official
Title or Position : ADMINISTRATOR
Name : DR. DMITRY MARGUSOV
Credential : D.C.
Telephone Number : 415-387-2750
Provider Enumeration Date : 05/08/2007
Last Update Date : 08/22/2020

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Directions to “GOLDEN STATE ADULT DAY HEALTH CARE INC ” Practice Location

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