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General NPI Number Information
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NPI Number | 1164055091
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Entity Type | Organization
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Legal Business Name | GOLDEN COMMUNITY CARE ADULT FAMILY HOME, LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 12121 E MISSION AVE STE C
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4832
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Country | US
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Telephone | 509-443-3102
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Fax |
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Provider Business Mailing Address
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Address Line | 12121 E MISSION AVE STE C
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4832
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Country | US
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Telephone | 509-443-3102
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MAHOULOME HAROLD GUIDI
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Credential |
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Telephone | 509-280-7164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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