Provider Demographics
NPI:1962618538
Name:GOLDEN ACRES ADULT DAY HEALTH CARE CENTER, INC
Entity type:Organization
Organization Name:GOLDEN ACRES ADULT DAY HEALTH CARE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-767-1361
Mailing Address - Street 1:12041 STRATHERN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1415
Mailing Address - Country:US
Mailing Address - Phone:818-767-1361
Mailing Address - Fax:818-767-1370
Practice Address - Street 1:12041 STRATHERN ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1415
Practice Address - Country:US
Practice Address - Phone:818-767-1361
Practice Address - Fax:818-767-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
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
CAADU70184FMedicaid