MEDICARE: GOLDEN PATH SERVICES II, CORP

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1992277792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN PATH SERVICES II, CORP

Provider Business Mailing Address
First Line	:	11019 W VILLA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2590
Country	:	US
Telephone Number	:	262-748-2596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 GROVE AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-3028
Country	:	US
Telephone Number	:	262-748-2596
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NICOSIA KING
Credential	:
Telephone Number	:	262-748-2596

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	03/29/2021

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