Provider Demographics
NPI:1326556259
Name:GOLDEN PROTECTION CDS HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOLDEN PROTECTION CDS HEALTHCARE LLC
Other - Org Name:GOLDEN PROTECTION CDS HEALTHCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAROD-PARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-733-5633
Mailing Address - Street 1:6539 ETZEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2607
Mailing Address - Country:US
Mailing Address - Phone:314-733-5633
Mailing Address - Fax:
Practice Address - Street 1:2400 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5523
Practice Address - Country:US
Practice Address - Phone:314-733-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid