Provider Demographics
NPI:1376022202
Name:GOLDEN MILES HOME SERVICES INC.
Entity Type:Organization
Organization Name:GOLDEN MILES HOME SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-955-2387
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:MS
Mailing Address - Zip Code:39066-0312
Mailing Address - Country:US
Mailing Address - Phone:601-955-2387
Mailing Address - Fax:
Practice Address - Street 1:203 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:MS
Practice Address - Zip Code:39066-8913
Practice Address - Country:US
Practice Address - Phone:601-955-2387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSED-IHR18086Medicaid
MSED-PCS18082Medicaid