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NPI Code Detail

MEDICARE: GOLDEN GROUP HOME SERVICES, LLC

MEDICARE: GOLDEN GROUP HOME SERVICES, LLC
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1396390811
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDEN GROUP HOME SERVICES, LLC
Provider Business Mailing Address
First Line : 28 STATE ST STE 4
Second Line :
City : GORHAM
State : ME
Zip : 04038-1147
Country : US
Telephone Number : 207-415-5393
Fax Number :
Provider Business Practice Location Address
First Line : 28 STATE ST STE 4
Second Line :
City : GORHAM
State : ME
Zip : 04038-1147
Country : US
Telephone Number : 207-415-5393
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. MICHEL KANYAMBO
Credential :
Telephone Number : 207-415-5393
Provider Enumeration Date : 08/02/2019
Last Update Date : 05/31/2021

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