Provider Demographics
NPI:1497739163
Name:GOLDEN HAVEN CARE, INC.
Entity Type:Organization
Organization Name:GOLDEN HAVEN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSAELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFRANCA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-358-1267
Mailing Address - Street 1:6525 NORTH AVE
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1033
Mailing Address - Country:US
Mailing Address - Phone:708-358-1267
Mailing Address - Fax:708-358-1240
Practice Address - Street 1:6525 NORTH AVE
Practice Address - Street 2:SUITE # 207
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1033
Practice Address - Country:US
Practice Address - Phone:708-358-1267
Practice Address - Fax:708-358-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1010301251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147768Medicare ID - Type Unspecified