Provider Demographics
NPI:1528391653
Name:GOLDEN GARDENS. LLC
Entity Type:Organization
Organization Name:GOLDEN GARDENS. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-897-8555
Mailing Address - Street 1:2636 N MITTHOEFFER PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1297
Mailing Address - Country:US
Mailing Address - Phone:317-897-8555
Mailing Address - Fax:317-897-8561
Practice Address - Street 1:2636 N MITTHOEFFER PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-1297
Practice Address - Country:US
Practice Address - Phone:317-897-8555
Practice Address - Fax:317-897-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care