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General NPI Number Information
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NPI Number | 1821346305
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Entity Type | Organization
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Legal Business Name | GOLDEN INDEPENDENCE LLC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 447 OLLIE ST
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9622
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Country | US
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Telephone | 608-839-0993
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Fax | 608-807-5168
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Provider Business Mailing Address
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Address Line | PO BOX 25
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-0025
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Country | US
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Telephone | 608-839-0993
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Fax | 608-807-5168
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYNN M HUGILL
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Credential |
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Telephone | 608-839-0993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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