Provider Demographics
NPI:1013572940
Name:TRANSITIONS OF GOLDEN SHIELDS LLC
Entity Type:Organization
Organization Name:TRANSITIONS OF GOLDEN SHIELDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:802-250-1282
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-0188
Mailing Address - Country:US
Mailing Address - Phone:803-250-1282
Mailing Address - Fax:800-781-1997
Practice Address - Street 1:85 WADING BIRD LOOP
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-5906
Practice Address - Country:US
Practice Address - Phone:802-250-1282
Practice Address - Fax:800-781-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children