Healthcare Provider Details

I. General information

NPI: 1952065542
Provider Name (Legal Business Name): GOLDEN HEIGHTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 WEST ST
NEW BERN NC
28560-4849
US

IV. Provider business mailing address

603 WEST ST
NEW BERN NC
28560-4849
US

V. Phone/Fax

Practice location:
  • Phone: 252-636-2722
  • Fax:
Mailing address:
  • Phone: 252-402-5415
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY BLOUNT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 252-402-5317