Provider Demographics
NPI:1730228867
Name:GOLDEN AGE CONVALESCENT HOSPITAL, INC
Entity type:Organization
Organization Name:GOLDEN AGE CONVALESCENT HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ESTERLITA
Authorized Official - Middle Name:CORTES
Authorized Official - Last Name:TAPANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-761-7000
Mailing Address - Street 1:523 BURLINGAME AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3307
Mailing Address - Country:US
Mailing Address - Phone:831-475-0722
Mailing Address - Fax:831-475-1048
Practice Address - Street 1:523 BURLINGAME AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3307
Practice Address - Country:US
Practice Address - Phone:831-475-0722
Practice Address - Fax:831-475-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR18415KMedicaid