MEDICARE: GOLDEN COMFORT HOLMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1154068260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN COMFORT HOLMES LLC

Provider Business Mailing Address
First Line	:	1503 GOTHAM CT
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-6918
Country	:	US
Telephone Number	:	813-841-2349
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 GOTHAM CT
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-6918
Country	:	US
Telephone Number	:	813-841-2349
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANTHONY L HOLMES JR.
Credential	:
Telephone Number	:	813-841-2349

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	05/19/2022

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