Provider Demographics
NPI:1548326671
Name:GOLDEN PERSONAL CARE HOME, INC.
Entity type:Organization
Organization Name:GOLDEN PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:GOLDEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-374-2483
Mailing Address - Street 1:257 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-3929
Mailing Address - Country:US
Mailing Address - Phone:478-374-2483
Mailing Address - Fax:478-374-7410
Practice Address - Street 1:257 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-3929
Practice Address - Country:US
Practice Address - Phone:478-374-2483
Practice Address - Fax:478-374-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility