MEDICARE: GOLDEN STATE HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1962163410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN STATE HOME CARE INC

Provider Business Mailing Address
First Line	:	10880 WILSHIRE BLVD STE 1106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4101
Country	:	US
Telephone Number	:	424-331-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	10880 WILSHIRE BLVD STE 1106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4101
Country	:	US
Telephone Number	:	424-331-1818
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VAHAGN TADEVOSYAN
Credential	:
Telephone Number	:	424-331-1818

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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Directions to “GOLDEN STATE HOME CARE INC ” Practice Location

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