Provider Demographics
NPI:1376145086
Name:GOLDEN LIVING
Entity Type:Organization
Organization Name:GOLDEN LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAESHA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-230-1481
Mailing Address - Street 1:17610 W PARAISO DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-4015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2357
Practice Address - Country:US
Practice Address - Phone:623-230-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health