Provider Demographics
NPI:1386151769
Name:GOLDEN STATE HEARING AID CENTER, INC.
Entity type:Organization
Organization Name:GOLDEN STATE HEARING AID CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-287-3272
Mailing Address - Street 1:101 COLLEGE AVE.
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5979
Mailing Address - Country:US
Mailing Address - Phone:209-287-3272
Mailing Address - Fax:209-287-3232
Practice Address - Street 1:101 COLLEGE AVE.
Practice Address - Street 2:SUITE 1A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5979
Practice Address - Country:US
Practice Address - Phone:209-287-3272
Practice Address - Fax:209-287-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7332237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherNEW BUSINESS