Provider Demographics
NPI:1316374192
Name:GOLDEN GENERATION LLC
Entity Type:Organization
Organization Name:GOLDEN GENERATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYD
Authorized Official - Suffix:
Authorized Official - Credentials:BA BUSINESS
Authorized Official - Phone:706-339-6749
Mailing Address - Street 1:351 KINGS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9616
Mailing Address - Country:US
Mailing Address - Phone:706-339-6749
Mailing Address - Fax:
Practice Address - Street 1:351 KINGS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9616
Practice Address - Country:US
Practice Address - Phone:706-339-6749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA146305913A320600000X
GA146305913B320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities