Provider Demographics
NPI:1437783875
Name:GOLDEN CENTER FOR HEALTH & HEALING, LLC
Entity Type:Organization
Organization Name:GOLDEN CENTER FOR HEALTH & HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-781-0805
Mailing Address - Street 1:2445 31ST AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6941
Mailing Address - Country:US
Mailing Address - Phone:309-781-0805
Mailing Address - Fax:309-429-6471
Practice Address - Street 1:319 18TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8715
Practice Address - Country:US
Practice Address - Phone:309-781-0805
Practice Address - Fax:309-429-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-062709OtherMEDICAL LICENSE