Provider Demographics
NPI:1356014062
Name:GOLDEN EAGLE HOME HEALTH
Entity Type:Organization
Organization Name:GOLDEN EAGLE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIGRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEGEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-206-5131
Mailing Address - Street 1:8448 RESEDA BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5992
Mailing Address - Country:US
Mailing Address - Phone:747-206-5131
Mailing Address - Fax:747-206-5135
Practice Address - Street 1:8448 RESEDA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5992
Practice Address - Country:US
Practice Address - Phone:747-206-5131
Practice Address - Fax:747-206-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health