Healthcare Provider Details

I. General information

NPI: 1457954984
Provider Name (Legal Business Name): GOLDEN OAKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 W 60TH PL
SHAWNEE KS
66203-2623
US

IV. Provider business mailing address

11701 W 60TH PL
SHAWNEE KS
66203-2623
US

V. Phone/Fax

Practice location:
  • Phone: 913-717-6257
  • Fax:
Mailing address:
  • Phone: 913-717-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: FELECIA FROE
Title or Position: OWNER
Credential: MD
Phone: 808-349-3412