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General NPI Number Information
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NPI Number | 1558751800
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Entity Type | Organization
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Legal Business Name | GOLDENOAKS
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 8099 GEOFFRION ST
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City | HEREFORD
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State | AZ
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Zip | 85615
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Country | US
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Telephone | 520-378-3077
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Fax | 520-378-3074
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Provider Business Mailing Address
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Address Line | 8099 S GEOFFRION ST 8099 GEOFFRION ST.
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City | HEREFORD
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State | AZ
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Zip | 85615-9706
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Country | US
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Telephone | 520-378-3077
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Fax | 520-378-3074
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. TRUDY ELIZABETH ALTAMIRANO
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Credential | MANAGER
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Telephone | 520-378-3077
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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 | AL4609H
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License Number State | AZ
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