=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770026973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN LOVE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2016
-----------------------------------------------------
Last Update Date | 11/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34987 MICHELLE DR
-----------------------------------------------------
City | ROMULUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48174-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-992-2884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34987 MICHELLE DR
-----------------------------------------------------
City | ROMULUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48174-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-992-2884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS TEASH POWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-992-2884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------