Healthcare Provider Details

I. General information

NPI: 1639758642
Provider Name (Legal Business Name): GOLDEN'S HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 CITICO DR APT 101
CORDOVA TN
38016-7682
US

IV. Provider business mailing address

2354 CITICO DR APT 101
CORDOVA TN
38016-7682
US

V. Phone/Fax

Practice location:
  • Phone: 217-850-5885
  • Fax:
Mailing address:
  • Phone: 217-850-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. KANISHA MORINE LYONS
Title or Position: CEO
Credential:
Phone: 217-850-5885