Healthcare Provider Details

I. General information

NPI: 1730801358
Provider Name (Legal Business Name): 5 GOLD STAR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/21/2023
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E COSTILLA ST
COLORADO SPRINGS CO
80903-2103
US

IV. Provider business mailing address

2020 N ACADEMY BLVD STE 348
COLORADO SPRINGS CO
80909-1567
US

V. Phone/Fax

Practice location:
  • Phone: 719-419-7977
  • Fax: 719-419-7988
Mailing address:
  • Phone: 719-419-7977
  • Fax: 719-419-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL WAYNE ALEXANDER JR.
Title or Position: OWNER
Credential:
Phone: 719-419-7977