Provider Demographics
NPI:1619033826
Name:LIFE'S GOLDEN HORIZONS, INC
Entity Type:Organization
Organization Name:LIFE'S GOLDEN HORIZONS, INC
Other - Org Name:ANTELOPE VALLEY ADULT DAY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTRELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGOLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-949-6278
Mailing Address - Street 1:42212 10TH ST W STE 8
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7005
Mailing Address - Country:US
Mailing Address - Phone:661-949-6278
Mailing Address - Fax:661-949-6768
Practice Address - Street 1:42212 10TH ST W STE 8
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7005
Practice Address - Country:US
Practice Address - Phone:661-949-6278
Practice Address - Fax:661-949-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70204GOtherMEDI-CAL PROVIDER NUMBER