Provider Demographics
NPI:1902977218
Name:GOLDEN AGE ADULT DAY HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:GOLDEN AGE ADULT DAY HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-9393
Mailing Address - Street 1:18332 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4219
Mailing Address - Country:US
Mailing Address - Phone:818-345-9393
Mailing Address - Fax:
Practice Address - Street 1:18332 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4219
Practice Address - Country:US
Practice Address - Phone:818-345-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
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