Healthcare Provider Details

I. General information

NPI: 1245020817
Provider Name (Legal Business Name): GOLDEN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 DULING AVE STE 201
JACKSON MS
39216-4009
US

IV. Provider business mailing address

603 DULING AVE STE 201
JACKSON MS
39216-4009
US

V. Phone/Fax

Practice location:
  • Phone: 945-267-6756
  • Fax:
Mailing address:
  • Phone: 945-267-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: STACY NECOL SMITH
Title or Position: OWNER
Credential:
Phone: 945-267-6756