MEDICARE: GOLDEN LAKES SUPPORT SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538025861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN LAKES SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	5800 RICKER RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1605
Country	:	US
Telephone Number	:	904-257-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 RICKER RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1605
Country	:	US
Telephone Number	:	904-257-3472
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TRACY CASON
Credential	:
Telephone Number	:	904-304-0704

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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