MEDICARE: SONYA L GOLDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1235715103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONYA L GOLDEN

Provider Business Mailing Address
First Line	:	7951 CHARLESTOWN LN
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76140-8642
Country	:	US
Telephone Number	:	469-563-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	5516 BRENTWOOD STAIR RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76112-2917
Country	:	US
Telephone Number	:	469-563-9068
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER/OWNER
Name	:	MS. SONYA L GOLDEN
Credential	:
Telephone Number	:	469-563-9068

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	02/26/2026

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