Healthcare Provider Details

I. General information

NPI: 1215237599
Provider Name (Legal Business Name): GOLDEN GATES GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12832 PEPPERTREE DR
PLAINFIELD IL
60585-2946
US

IV. Provider business mailing address

12832 PEPPERTREE DR
PLAINFIELD IL
60585-2946
US

V. Phone/Fax

Practice location:
  • Phone: 331-472-9824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA SAMPAH
Title or Position: PRESIDENT
Credential:
Phone: 331-472-9824