- Enrollment id
- O20241107002319
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1992454052
- Multiple npi flag
- N
- Ccn
- 758029
- Associate id
- 8224562624
- Organization name
- GOLDEN AGE SKILLED SERVICES
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 18340 VENTURA BLVD
- Address line 2
- STE 229
- City
- TARZANA
- State
- CA
- Zip code
- 913567005