MEDICARE: GOLDEN VISTA HOME 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1386147726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN VISTA HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	5890 S DURANGO DR STE 100B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2319
Country	:	US
Telephone Number	:	702-268-8615
Fax Number	:	702-665-6525

Provider Business Practice Location Address
First Line	:	5890 S DURANGO DR STE 100B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2319
Country	:	US
Telephone Number	:	702-268-8615
Fax Number	:	702-665-6525

Authorized Official
Title or Position	:	ADMINISTRATOR/PRESIDENT
Name	:	MR. DANIELLE TIMOTHY R GO
Credential	:
Telephone Number	:	702-467-9038

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	06/01/2022

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