MEDICARE: GOLDA 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1528575644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDA LLC

Provider Business Mailing Address
First Line	:	5868 WESTHEIMER RD
Second Line	:	# 336
City	:	HOUSTON
State	:	TX
Zip	:	77057
Country	:	US
Telephone Number	:	713-501-6013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 POST OAK BLVD FL 21
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-5797
Country	:	US
Telephone Number	:	713-501-6013
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMEBER
Name	:	PROKHOR GALDABARANOVSKIY
Credential	:
Telephone Number	:	713-501-6013

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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Directions to “GOLDA LLC ” Practice Location

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