Provider Demographics
NPI:1437738093
Name:GOLDEN GATE MANOR INC
Entity Type:Organization
Organization Name:GOLDEN GATE MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-369-6290
Mailing Address - Street 1:612 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2244
Mailing Address - Country:US
Mailing Address - Phone:719-924-9932
Mailing Address - Fax:
Practice Address - Street 1:612 S UNION AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2244
Practice Address - Country:US
Practice Address - Phone:719-924-9932
Practice Address - Fax:719-696-8548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN GATE MANOR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies