Healthcare Provider Details

I. General information

NPI: 1407636079
Provider Name (Legal Business Name): GOLDEN DOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5286 S COMMERCE DR STE A136
MURRAY UT
84107-4765
US

IV. Provider business mailing address

5286 S COMMERCE DR STE A136
MURRAY UT
84107-4765
US

V. Phone/Fax

Practice location:
  • Phone: 385-487-7373
  • Fax:
Mailing address:
  • Phone: 385-487-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MAAKE SAMI ULUIVITI
Title or Position: OWNER
Credential: MU
Phone: 801-989-2473