Provider Demographics
NPI:1073755104
Name:GOLDEN GIRL, INC.
Entity Type:Organization
Organization Name:GOLDEN GIRL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, ALPS, LSW
Authorized Official - Phone:304-453-1401
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:CEREDO
Mailing Address - State:WV
Mailing Address - Zip Code:25507-0876
Mailing Address - Country:US
Mailing Address - Phone:304-453-1401
Mailing Address - Fax:304-453-6273
Practice Address - Street 1:999 B STREET
Practice Address - Street 2:
Practice Address - City:CEREDO
Practice Address - State:WV
Practice Address - Zip Code:22507-0876
Practice Address - Country:US
Practice Address - Phone:304-453-1401
Practice Address - Fax:304-453-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023496003Medicaid