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NPI Code Detail

MEDICARE: GOLGOTA HEALTH SERVICES INC

MEDICARE: GOLGOTA HEALTH SERVICES INC
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
1251C00000XDevelopmentally Disabled Services Day Training Agency

General Provider Information

NPI Number : 1366043317
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLGOTA HEALTH SERVICES INC
Provider Business Mailing Address
First Line : 4216 EVERGREEN LN STE 133
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-3256
Country : US
Telephone Number : 443-286-9323
Fax Number :
Provider Business Practice Location Address
First Line : 4216 EVERGREEN LN STE 133
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-3256
Country : US
Telephone Number : 443-286-9323
Fax Number :
Authorized Official
Title or Position : CEO
Name : GOLGOTA HEALTH SERVICES INC
Credential :
Telephone Number : 443-286-9323
Provider Enumeration Date : 11/05/2020
Last Update Date : 11/05/2020

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Directions to “GOLGOTA HEALTH SERVICES INC ” Practice Location

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