Healthcare Provider Details

I. General information

NPI: 1255695961
Provider Name (Legal Business Name): GOLDSTAR ADULT DAY CARE CENTER LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 HOPKINS XRD
MINNETONKA MN
55305-2029
US

IV. Provider business mailing address

1712 HOPKINS XRD
MINNETONKA MN
55305-2029
US

V. Phone/Fax

Practice location:
  • Phone: 612-306-4957
  • Fax: 763-546-7888
Mailing address:
  • Phone: 612-306-4957
  • Fax: 763-546-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: MRS. NATASHA NOVIK
Title or Position: CEO
Credential:
Phone: 612-306-4957