Provider Demographics
NPI:1538764691
Name:GOLDEN LIFE HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:GOLDEN LIFE HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-899-2173
Mailing Address - Street 1:6424 W FOND DU LAC AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4964
Mailing Address - Country:US
Mailing Address - Phone:262-899-2173
Mailing Address - Fax:
Practice Address - Street 1:6424 W FOND DU LAC AVE STE 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4964
Practice Address - Country:US
Practice Address - Phone:262-899-2173
Practice Address - Fax:262-923-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health