MEDICARE: GOLDEN LIVING

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	314000000X	Skilled Nursing Facility	2389-19	WI

General Provider Information

NPI Number	:	1710352596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN LIVING

Provider Business Mailing Address
First Line	:	925 S OXFORD AVE
Second Line	:	B2
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-3907
Country	:	US
Telephone Number	:	920-495-6533
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 S OXFORD AVE
Second Line	:	B2
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-3907
Country	:	US
Telephone Number	:	920-495-6533
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST ASSISTANT
Name	:	ASHLEY ANNA HALL
Credential	:
Telephone Number	:	920-495-6533

Provider Enumeration Date	:	12/05/2015
Last Update Date	:	12/05/2015

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Directions to “GOLDEN LIVING ” Practice Location

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