MEDICARE: GOLDEN CIRCLE COMPREHENSIVE 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
1	253Z00000X	In Home Supportive Care Agency
2	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1770238073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN CIRCLE COMPREHENSIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	2801 WASHINGTON RD STE 107
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2355
Country	:	US
Telephone Number	:	706-945-8617
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 FORT AUGUSTA ST
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-7214
Country	:	US
Telephone Number	:	706-945-8617
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ELLEN V TAYLOR
Credential	:	DM
Telephone Number	:	706-945-8617

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	02/15/2022

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