MEDICARE: GOLDEN AGE ASSISTED LIVING

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	:	1700716123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE ASSISTED LIVING

Provider Business Mailing Address
First Line	:	11749 WELBY WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1624
Country	:	US
Telephone Number	:	818-433-4432
Fax Number	:	818-433-4432

Provider Business Practice Location Address
First Line	:	11749 WELBY WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1624
Country	:	US
Telephone Number	:	818-433-4432
Fax Number	:	818-433-4432

Authorized Official
Title or Position	:	OWNER
Name	:	GAGIK HARUTYUNYAN
Credential	:
Telephone Number	:	323-823-3437

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “GOLDEN AGE ASSISTED LIVING ” Practice Location

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