Provider Demographics
NPI:1043945132
Name:GOLDEN GROVES RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:GOLDEN GROVES RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCFE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-803-3899
Mailing Address - Street 1:2841 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1406
Mailing Address - Country:US
Mailing Address - Phone:562-426-8989
Mailing Address - Fax:562-306-1135
Practice Address - Street 1:2841 GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1406
Practice Address - Country:US
Practice Address - Phone:562-426-8989
Practice Address - Fax:562-306-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA198320174OtherCDSS FACILITY NUMBER