Provider Demographics
NPI:1225167364
Name:GOLDEN OAKS, LLC
Entity Type:Organization
Organization Name:GOLDEN OAKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:660-886-6172
Mailing Address - Street 1:RR 1 BOX 19
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-9508
Mailing Address - Country:US
Mailing Address - Phone:660-886-6172
Mailing Address - Fax:660-886-7599
Practice Address - Street 1:RR 1 BOX 19
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-9508
Practice Address - Country:US
Practice Address - Phone:660-886-6172
Practice Address - Fax:660-886-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033694310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility