Provider Demographics
NPI:1821679382
Name:GOLDEN VILLAGE
Entity Type:Organization
Organization Name:GOLDEN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAYOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-528-6469
Mailing Address - Street 1:11555 RICHMONT RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3524
Mailing Address - Country:US
Mailing Address - Phone:909-796-0014
Mailing Address - Fax:
Practice Address - Street 1:11554 RICHMONT RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3525
Practice Address - Country:US
Practice Address - Phone:909-796-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility