Provider Demographics
NPI:1710792270
Name:GOLDEN, EBONY KATRINA
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:KATRINA
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13119 REXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-7067
Mailing Address - Country:US
Mailing Address - Phone:216-973-3053
Mailing Address - Fax:
Practice Address - Street 1:13119 REXWOOD AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-7067
Practice Address - Country:US
Practice Address - Phone:216-973-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide