Provider Demographics
NPI:1396390811
Name:GOLDEN GROUP HOME SERVICES, LLC
Entity Type:Organization
Organization Name:GOLDEN GROUP HOME SERVICES, LLC
Other - Org Name:LIMITED LIABILITY COMPANY (LLC)
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANYAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-415-5393
Mailing Address - Street 1:28 STATE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1147
Mailing Address - Country:US
Mailing Address - Phone:207-415-5393
Mailing Address - Fax:
Practice Address - Street 1:28 STATE ST STE 4
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1147
Practice Address - Country:US
Practice Address - Phone:207-415-5393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities