Provider Demographics
NPI:1154095305
Name:GOLDEN SUMMIT CARE
Entity Type:Organization
Organization Name:GOLDEN SUMMIT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MUJAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGOUB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-806-4408
Mailing Address - Street 1:2530 MERIDIAN PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5273
Mailing Address - Country:US
Mailing Address - Phone:919-806-4408
Mailing Address - Fax:
Practice Address - Street 1:2530 MERIDIAN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5273
Practice Address - Country:US
Practice Address - Phone:919-806-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health