Provider Demographics
NPI:1912452913
Name:GOLDEN GARDENS RCFE
Entity Type:Organization
Organization Name:GOLDEN GARDENS RCFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-645-3325
Mailing Address - Street 1:725 GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3447
Mailing Address - Country:US
Mailing Address - Phone:760-645-3325
Mailing Address - Fax:760-645-3635
Practice Address - Street 1:725 GOLDEN LN
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3447
Practice Address - Country:US
Practice Address - Phone:760-645-3325
Practice Address - Fax:760-645-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374602987310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility