Provider Demographics
NPI:1275128449
Name:GOLDEN UPSTATE HOME BASE CARE LLC
Entity Type:Organization
Organization Name:GOLDEN UPSTATE HOME BASE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELDA
Authorized Official - Middle Name:CALANDRA
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-213-6311
Mailing Address - Street 1:1200 WOODRUFF RD STE A3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5732
Mailing Address - Country:US
Mailing Address - Phone:864-213-6311
Mailing Address - Fax:
Practice Address - Street 1:1200 WOODRUFF RD STE A3
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5732
Practice Address - Country:US
Practice Address - Phone:864-213-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care