- Enrollment id
- O20021204000008
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1578561791
- Multiple npi flag
- N
- Ccn
- 058262
- Associate id
- 0446168603
- Organization name
- GOLDEN AGE HOME HEALTHCARE INC.
- Incorporation date
- 2002-04-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 9029 RESEDA BLVD
- Address line 2
- STE 101
- City
- NORTHRIDGE
- State
- CA
- Zip code
- 913243932
- Practice location type
- HHA BRANCH