Provider Demographics
NPI:1861290827
Name:GOLDEN LIVING RESIDENTIAL LLC
Entity type:Organization
Organization Name:GOLDEN LIVING RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-646-2203
Mailing Address - Street 1:55 BENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4324
Mailing Address - Country:US
Mailing Address - Phone:301-646-2203
Mailing Address - Fax:301-646-2203
Practice Address - Street 1:12178 LINCOLN LAKE WAY UNIT 207
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7760
Practice Address - Country:US
Practice Address - Phone:301-646-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services