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General NPI Number Information
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NPI Number | 1699127639
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Entity Type | Organization
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Legal Business Name | GOLDEN LIFE FAMILY CARE HOME, LLC.
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 1002 WESTMINSTER LN
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City | KINSTON
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State | NC
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Zip | 28501-2766
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Country | US
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Telephone | 252-208-8479
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674
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City | KINSTON
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State | NC
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Zip | 28502-0674
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ASHLEY NICOLE CRATCH
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Credential |
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Telephone | 252-208-8479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | FCL054072
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | FCL054072
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | FCL054072
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | FCL054072
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | FCL054072
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL054072
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | FCL054072
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number | FCL054072
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number | FCL054072
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License Number State | NC
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Taxonomy #10
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | FCL054072
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License Number State | NC
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