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General NPI Number Information
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NPI Number | 1427242312
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Entity Type | Organization
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Legal Business Name | GOLDEN GIRLS RESIDENTIAL LIVING
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 6827 W ROWEL RD
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City | PEORIA
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State | AZ
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Zip | 85383-7040
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Country | US
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Telephone | 623-414-3004
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Fax | 623-414-3771
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Provider Business Mailing Address
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Address Line | 6827 W ROWEL RD
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City | PEORIA
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State | AZ
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Zip | 85383-7040
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Country | US
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Telephone | 623-414-3004
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Fax | 623-414-3771
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Authorized Official
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Title or Position | PRESIDENT/GENERLA MANAGE
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Name | MR. ILUMINADO LANDOY CALISANG
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Credential |
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Telephone | 623-414-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALH5905
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License Number State | AZ
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