Healthcare Provider Details

I. General information

NPI: 1548016157
Provider Name (Legal Business Name): GOLDEN WIND GROUP HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 N 15TH AVE
PHOENIX AZ
85015-3308
US

IV. Provider business mailing address

900 S HARRISON ST APT 1
DENVER CO
80209-5041
US

V. Phone/Fax

Practice location:
  • Phone: 602-703-8261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VALENA JORDAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-782-0216