Healthcare Provider Details

I. General information

NPI: 1891919551
Provider Name (Legal Business Name): GOLDEN TRIANGLE LIVING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 HUNTSMAN ST
ORANGE TX
77632-1848
US

IV. Provider business mailing address

715 MAIN ST
PINEVILLE LA
71360-6937
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES E. RICHARDSON
Title or Position: C.E.O.
Credential:
Phone: 318-445-6470