Provider Demographics
NPI:1083481584
Name:GOLDWINGS HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOLDWINGS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-790-7431
Mailing Address - Street 1:6065 ROSWELL RD STE 450
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4011
Mailing Address - Country:US
Mailing Address - Phone:800-722-1975
Mailing Address - Fax:
Practice Address - Street 1:4600 ROSWELL RD BLDG H120
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-3006
Practice Address - Country:US
Practice Address - Phone:678-790-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care