Provider Demographics
NPI:1427209048
Name:GOLDEN AGE SENIOR LIVING INC.
Entity Type:Organization
Organization Name:GOLDEN AGE SENIOR LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARICEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TINIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-522-3812
Mailing Address - Street 1:230 SWEET RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-7798
Mailing Address - Country:US
Mailing Address - Phone:510-522-3812
Mailing Address - Fax:510-903-1312
Practice Address - Street 1:218 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6452
Practice Address - Country:US
Practice Address - Phone:510-522-3812
Practice Address - Fax:510-903-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015600840310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)