Provider Demographics
NPI:1285670851
Name:GOLDEN OAK HOLDINGS, LLC
Entity Type:Organization
Organization Name:GOLDEN OAK HOLDINGS, LLC
Other - Org Name:VASONA CREEK HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-450-3881
Mailing Address - Street 1:16412 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5525
Mailing Address - Country:US
Mailing Address - Phone:408-356-2191
Mailing Address - Fax:408-356-9432
Practice Address - Street 1:16412 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5525
Practice Address - Country:US
Practice Address - Phone:408-356-2191
Practice Address - Fax:408-356-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000153314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05798JMedicaid
CA1285670851Medicaid
CA1285670851Medicaid
CA1285670851Medicaid