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General NPI Number Information
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NPI Number | 1366728958
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Entity Type | Organization
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Legal Business Name | GOLDEN HEALTHCARE ADVANTAGE CORP
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 6401 DUQUESNE PL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4430
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Country | US
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Telephone | 757-401-0992
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 DUQUESNE PL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4430
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Country | US
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Telephone | 757-401-0992
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Fax |
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Authorized Official
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Title or Position | PRES/CEO
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Name | MR. FRANCIS I AIKHU
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Credential |
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Telephone | 757-401-0992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 07426513
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License Number State | VA
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