Provider Demographics
NPI:1336680206
Name:GOLDEN GIRLS HOMECARE
Entity Type:Organization
Organization Name:GOLDEN GIRLS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:607-316-9931
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:116 MARTINSON LANE
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-0177
Mailing Address - Country:US
Mailing Address - Phone:607-316-9931
Mailing Address - Fax:
Practice Address - Street 1:116 MARTINSON LANE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-0177
Practice Address - Country:US
Practice Address - Phone:607-316-9931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146323-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health