MEDICARE: GOLDEN AGE HOME HEALTHCARE 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	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1578561791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE HOME HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	9003 RESEDA BLVD
Second Line	:	STE 205
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3920
Country	:	US
Telephone Number	:	818-718-4680
Fax Number	:	818-718-4664

Provider Business Practice Location Address
First Line	:	9003 RESEDA BLVD
Second Line	:	STE 205
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3920
Country	:	US
Telephone Number	:	818-718-4680
Fax Number	:	818-718-4664

Authorized Official
Title or Position	:	ADMIN. / DIRECTOR OF PATIENT CARE
Name	:	MS. CARIDAD G CORPUS
Credential	:	RN
Telephone Number	:	818-718-4664

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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