Healthcare Provider Details

I. General information

NPI: 1235996315
Provider Name (Legal Business Name): GOLDENSTAR GROUP HOMES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 FLEUR DR APT 102
DES MOINES IA
50321-1735
US

IV. Provider business mailing address

2802 FLEUR DR APT 102
DES MOINES IA
50321-1735
US

V. Phone/Fax

Practice location:
  • Phone: 515-707-9155
  • Fax:
Mailing address:
  • Phone: 515-707-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMED SALAH
Title or Position: CEO
Credential:
Phone: 515-707-9155