Provider Demographics
NPI:1407342728
Name:GOLDEN HOLISTIC TREATMENT CENTER
Entity Type:Organization
Organization Name:GOLDEN HOLISTIC TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:EO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-450-2195
Mailing Address - Street 1:6809 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1807
Mailing Address - Country:US
Mailing Address - Phone:201-766-0015
Mailing Address - Fax:201-766-0019
Practice Address - Street 1:6809 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1807
Practice Address - Country:US
Practice Address - Phone:201-766-0015
Practice Address - Fax:201-766-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain