Provider Demographics
NPI:1417160045
Name:GOLDEN AGE HOME HEALTH INC
Entity Type:Organization
Organization Name:GOLDEN AGE HOME HEALTH INC
Other - Org Name:PRN HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANTEFLOR
Authorized Official - Middle Name:P
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-761-5511
Mailing Address - Street 1:15600 DEVONSHIRE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7242
Mailing Address - Country:US
Mailing Address - Phone:818-761-5511
Mailing Address - Fax:818-761-6611
Practice Address - Street 1:15600 DEVONSHIRE ST STE 206
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7242
Practice Address - Country:US
Practice Address - Phone:818-761-5511
Practice Address - Fax:818-761-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000856251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059091Medicare Oscar/Certification