Provider Demographics
NPI:1215140843
Name:GOLDEN STATE ADULT DAY HEALTH CARE INC
Entity type:Organization
Organization Name:GOLDEN STATE ADULT DAY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGUSOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-387-2750
Mailing Address - Street 1:738 LA PLAYA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3262
Mailing Address - Country:US
Mailing Address - Phone:451-387-2750
Mailing Address - Fax:415-387-2712
Practice Address - Street 1:738 LA PLAYA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3262
Practice Address - Country:US
Practice Address - Phone:451-387-2750
Practice Address - Fax:415-387-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70287FMedicaid