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General NPI Number Information
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NPI Number | 1609129469
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Entity Type | Organization
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Legal Business Name | GOLDEN ACRE RESIDENTIAL CARE, LLC.
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 8253 STONEHAM DR
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City | YPSILANTI
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State | MI
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Zip | 48197-6607
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Country | US
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Telephone | 734-547-5058
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Fax | 734-547-5449
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Provider Business Mailing Address
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Address Line | 8253 STONEHAM DR
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City | YPSILANTI
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State | MI
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Zip | 48197-6607
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Country | US
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Telephone | 734-547-5058
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Fax | 734-547-5449
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LAURA ETTA SARRACH
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Credential | REGISTERED NURSE
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Telephone | 734-620-3895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS82030507
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License Number State | MI
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