Provider Demographics
NPI:1568135408
Name:GOLDEN WINGS HOSPICE LLC.
Entity Type:Organization
Organization Name:GOLDEN WINGS HOSPICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/LVN
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGULAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-254-7261
Mailing Address - Street 1:514 COMMERCE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 E PALMDALE BLVD STE D-3
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4549
Practice Address - Country:US
Practice Address - Phone:661-206-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based