Provider Demographics
NPI:1477603751
Name:GOLDEN GATE HOMES,INC.
Entity Type:Organization
Organization Name:GOLDEN GATE HOMES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-580-5992
Mailing Address - Street 1:223 W WALNUT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3684
Mailing Address - Country:US
Mailing Address - Phone:919-580-5992
Mailing Address - Fax:919-580-5993
Practice Address - Street 1:516 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4760
Practice Address - Country:US
Practice Address - Phone:919-580-5992
Practice Address - Fax:919-580-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-096-181320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness