Healthcare Provider Details

I. General information

NPI: 1528391653
Provider Name (Legal Business Name): GOLDEN GARDENS. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 N MITTHOEFFER PL
INDIANAPOLIS IN
46229-1297
US

IV. Provider business mailing address

2636 N MITTHOEFFER PL
INDIANAPOLIS IN
46229-1297
US

V. Phone/Fax

Practice location:
  • Phone: 317-897-8555
  • Fax: 317-897-8561
Mailing address:
  • Phone: 317-897-8555
  • Fax: 317-897-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

Name: MS. KIMBERLY DIXON
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-897-8555