Provider Demographics
NPI:1679749766
Name:GOLDEN SEAL HOME HEALTH, INC
Entity type:Organization
Organization Name:GOLDEN SEAL HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:DESLATE
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:BILLER
Authorized Official - Phone:213-381-7370
Mailing Address - Street 1:1711 WEST TEMPLE ST.
Mailing Address - Street 2:SUITE 7607
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026
Mailing Address - Country:US
Mailing Address - Phone:213-381-7370
Mailing Address - Fax:213-483-1828
Practice Address - Street 1:1711 WEST TEMPLE ST.
Practice Address - Street 2:SUITE 7607
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:213-381-7370
Practice Address - Fax:213-483-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059257Medicare Oscar/Certification