Golden State Home Health Agency, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

GOLDEN STATE HOME HEALTH AGENCY, INC

Practice address

21133 Victory Blvd Ste 203
Canoga Park, CA 91303-4016

Phone

(818) 835-9888

NPI assigned

Nov 18, 2021

Last updated

Nov 18, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rafayel Nersisyan

Title

Ceo

Phone

(310) 562-7382

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578220182. Details of each certification follow.

• CCN 757414 Home health agency · Active · Details

Home health agency certification: CCN 757414

Legal name

GOLDEN STATE HOME HEALTH AGENCY INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 21, 2023

Last certification

Aug 15, 2023

Organization structure

CorporationProprietary

Incorporated

Feb 2, 2021 in CA

Enrollment address

21133 Victory Blvd
Ste 203
Canoga Park, CA 91303-4016

Listed as

Golden State Home Health AgencyCCN 757414 · All quality measures

Ownership

-

Certified

Aug 21, 2023

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Dale J Brent, MD

  • Internal Medicine Physician
  • Sherman Oaks, CA
  • NPI 1992886618

  Home health agency

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1578220182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20741 DOLOROSA ST",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913676837",
            "telephone_number": "310-562-7382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21133 VICTORY BLVD STE 203",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913034016",
            "telephone_number": "818-835-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN STATE HOME HEALTH AGENCY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-18",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A",
        "authorized_official_last_name": "NERSISYAN",
        "authorized_official_first_name": "RAFAYEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-562-7382"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Patricia Giron, RDA
• Kimiya Gladney
• Jamal Glasgow
• Charles Gochuico
• Golden Life Home Health, Inc.
• Golden Years Boarding Care
• Amy Goldring Firestein
• Julia Adrienne Golizio
• Dayany Gomez Gonzalez
• Ashley Gomez Lopez

• Home Health Agency in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.