MEDICARE: GOLDEN GATES HEALTHCARE 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	3747P1801X	Personal Care Attendant	15186	LA

General Provider Information

NPI Number	:	1982845541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN GATES HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 83135
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70884-3135
Country	:	US
Telephone Number	:	225-218-6819
Fax Number	:	225-218-6842

Provider Business Practice Location Address
First Line	:	1713 WOODDALE BLVD
Second Line	:	SUITE 6
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1570
Country	:	US
Telephone Number	:	225-218-6819
Fax Number	:	225-218-6842

Authorized Official
Title or Position	:	OWNER
Name	:	ALETHA SMITH
Credential	:
Telephone Number	:	225-572-7193

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	03/11/2009

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