Healthcare Provider Details

I. General information

NPI: 1598879413
Provider Name (Legal Business Name): GOLDEN TRIANGLE LIVING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 NAVAJO TRAIL
BEAUMONT TX
77708
US

IV. Provider business mailing address

2750 SOUTH 4TH STREET
BEAUMONT TX
77701-7912
US

V. Phone/Fax

Practice location:
  • Phone: 409-898-4605
  • Fax: 409-832-8044
Mailing address:
  • Phone: 409-832-4112
  • Fax: 409-832-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number114962
License Number StateTX

VIII. Authorized Official

Name: MRS. JERRINE B HARRELL
Title or Position: PRESIDENT
Credential:
Phone: 318-445-6470