Provider Demographics
NPI:1447882782
Name:GOLDEN STATE RECUPERATIVE CARE, INC.
Entity type:Organization
Organization Name:GOLDEN STATE RECUPERATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-475-1127
Mailing Address - Street 1:153 E. 110TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061
Mailing Address - Country:US
Mailing Address - Phone:323-475-1126
Mailing Address - Fax:323-475-1132
Practice Address - Street 1:153 E. 110TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061
Practice Address - Country:US
Practice Address - Phone:323-475-1126
Practice Address - Fax:323-475-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No177F00000XOther Service ProvidersLodging
No251X00000XAgenciesSupports Brokerage