Healthcare Provider Details

I. General information

NPI: 1013385582
Provider Name (Legal Business Name): GOLDEN LIFE HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 MAITLAND DR
FAYETTEVILLE NC
28314-6296
US

IV. Provider business mailing address

2038 MAITLAND DR
FAYETTEVILLE NC
28314-6296
US

V. Phone/Fax

Practice location:
  • Phone: 910-728-5594
  • Fax:
Mailing address:
  • Phone: 910-728-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LILA L HUFF
Title or Position: LICENSED PRACTICAL NURSE
Credential:
Phone: 910-728-5594