Provider Demographics
NPI:1174280143
Name:GOLDEN LIFE CARE LLC
Entity Type:Organization
Organization Name:GOLDEN LIFE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GUERTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGIRIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-408-1214
Mailing Address - Street 1:18 PIN OAK DR APT 1807
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8256
Mailing Address - Country:US
Mailing Address - Phone:207-448-1214
Mailing Address - Fax:
Practice Address - Street 1:18 PIN OAK DR APT 1807
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8256
Practice Address - Country:US
Practice Address - Phone:207-448-1214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities