Provider Demographics
NPI:1326822875
Name:GOLDEN KEYS PEDIATRIC WELLNESS, LLC
Entity Type:Organization
Organization Name:GOLDEN KEYS PEDIATRIC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-364-7044
Mailing Address - Street 1:3455 VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3736
Mailing Address - Country:US
Mailing Address - Phone:262-364-7044
Mailing Address - Fax:
Practice Address - Street 1:3455 VIEW AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3736
Practice Address - Country:US
Practice Address - Phone:262-364-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency