Healthcare Provider Details

I. General information

NPI: 1821448416
Provider Name (Legal Business Name): GOLDEN CARE ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 MULLANPHY ST. SUITE 113
ST. LOUIS MO
63106-3114
US

IV. Provider business mailing address

1451 MULLANPHY ST. SUITE 113
ST. LOUIS MO
63106-3114
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-3995
  • Fax: 888-504-9013
Mailing address:
  • Phone: 314-361-3995
  • Fax: 888-504-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JANICE Y GRIFFIN
Title or Position: PRESIDENT
Credential:
Phone: 314-361-3995