Provider Demographics
NPI:1043708258
Name:GOLDEN AGE BAY AREA LLC
Entity Type:Organization
Organization Name:GOLDEN AGE BAY AREA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-881-7815
Mailing Address - Street 1:20212 REDWOOD RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4374
Mailing Address - Country:US
Mailing Address - Phone:510-881-7815
Mailing Address - Fax:
Practice Address - Street 1:20212 REDWOOD RD STE 103A
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4374
Practice Address - Country:US
Practice Address - Phone:510-881-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health