Provider Demographics
NPI:1578561791
Name:GOLDEN AGE HOME HEALTHCARE INC.
Entity Type:Organization
Organization Name:GOLDEN AGE HOME HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. / DIRECTOR OF PATIENT CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-718-4664
Mailing Address - Street 1:9003 RESEDA BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3920
Mailing Address - Country:US
Mailing Address - Phone:818-718-4680
Mailing Address - Fax:818-718-4664
Practice Address - Street 1:9003 RESEDA BLVD
Practice Address - Street 2:STE 205
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3920
Practice Address - Country:US
Practice Address - Phone:818-718-4680
Practice Address - Fax:818-718-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
058262Medicare ID - Type Unspecified