Healthcare Provider Details

I. General information

NPI: 1730320060
Provider Name (Legal Business Name): GOLDEN GIRL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 B STREET
CEREDO WV
25507-0876
US

IV. Provider business mailing address

PO BOX 876
CEREDO WV
25507-0876
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-1401
  • Fax: 304-453-6273
Mailing address:
  • Phone: 304-453-1401
  • Fax: 304-453-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEAH RENEE HARRISON
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LPC, ALPS, LSW
Phone: 304-453-1401