Provider Demographics
NPI:1962558239
Name:SILVER AGE HOME HEALTH CARE AGENCY, INC.
Entity type:Organization
Organization Name:SILVER AGE HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELITO
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-385-5788
Mailing Address - Street 1:520 S LA FAYETTE PARK PL STE 100-B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5402
Mailing Address - Country:US
Mailing Address - Phone:213-385-5788
Mailing Address - Fax:213-385-5850
Practice Address - Street 1:520 S LA FAYETTE PARK PL STE 100-B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5402
Practice Address - Country:US
Practice Address - Phone:213-385-5788
Practice Address - Fax:213-385-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-08-10
Deactivation Date:2023-05-22
Deactivation Code:
Reactivation Date:2023-08-09
Provider Licenses
StateLicense IDTaxonomies
CA550000242251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health