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General NPI Number Information
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NPI Number | 1174217590
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Entity Type | Organization
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Legal Business Name | GOLDEN FRONTIER CARE SERVICES INC
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 3226 HAMLET DR
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City | WOODBURY
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State | MN
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Zip | 55125-2709
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Country | US
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Telephone | 651-890-6055
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Fax | 651-350-1033
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Provider Business Mailing Address
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Address Line | 3226 HAMLET DR
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City | WOODBURY
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State | MN
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Zip | 55125-2709
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Country | US
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Telephone | 651-890-6055
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Fax | 651-350-1033
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Authorized Official
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Title or Position | OWNER/ ADMINISTER
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Name | FATUMA D KOTILE
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Credential |
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Telephone | 651-890-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number |
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License Number State | NULL
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