MEDICARE: GOLDEN LIGHT HEALTH CARE, LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1962863852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN LIGHT HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	115 PINE AVE
Second Line	:	SUITE 620
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4457
Country	:	US
Telephone Number	:	424-277-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 PINE AVE
Second Line	:	SUITE 620
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4457
Country	:	US
Telephone Number	:	424-277-0404
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHIMDI AZUBUIKE
Credential	:
Telephone Number	:	424-277-0404

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/18/2016

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