Provider Demographics
NPI:1508563958
Name:GOLDEN GIRLS OF LLA
Entity Type:Organization
Organization Name:GOLDEN GIRLS OF LLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:NRCMA STNA
Authorized Official - Phone:216-990-6928
Mailing Address - Street 1:55 MEADOWGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2209
Mailing Address - Country:US
Mailing Address - Phone:216-510-6777
Mailing Address - Fax:216-510-6777
Practice Address - Street 1:55 MEADOWGATE BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2209
Practice Address - Country:US
Practice Address - Phone:216-510-6777
Practice Address - Fax:216-510-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH184945OtherNRCMA
OH602333940421OtherSTATE TESTED NURSE ASSISTANT
OH03-8252OtherLICENSE TO OPERATE A RESIDENTIAL FACILITY
OH415856OtherDODD