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General NPI Number Information
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NPI Number | 1174280143
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Entity Type | Organization
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Legal Business Name | GOLDEN LIFE CARE LLC
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 18 PIN OAK DR APT 1807
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8256
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Country | US
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Telephone | 207-448-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 18 PIN OAK DR APT 1807
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8256
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Country | US
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Telephone | 207-448-1214
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. GUERTHE BIGIRIMANA
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Credential | DSP
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Telephone | 207-408-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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