Provider Demographics
NPI:1114317542
Name:GOLDEN BERRY INC.
Entity Type:Organization
Organization Name:GOLDEN BERRY INC.
Other - Org Name:GOLDEN YEARS CARE HOME 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISTOBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-487-1975
Mailing Address - Street 1:34881 HERRINGBONE WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4686
Mailing Address - Country:US
Mailing Address - Phone:510-487-1975
Mailing Address - Fax:916-688-9089
Practice Address - Street 1:8516 FOXBERRY CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1244
Practice Address - Country:US
Practice Address - Phone:916-681-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347003562310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility