Healthcare Provider Details

I. General information

NPI: 1740504984
Provider Name (Legal Business Name): GOLDEN TRIANGLE LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OGLESBEE RD
SILSBEE TX
77656-5925
US

IV. Provider business mailing address

2750 S 4TH ST
BEAUMONT TX
77701-7912
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-5807
  • Fax: 318-641-3717
Mailing address:
  • Phone: 409-832-4112
  • Fax: 318-641-3717

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: MR. JAMES E RICHARDSON
Title or Position: CEO
Credential:
Phone: 318-445-6470