Provider Demographics
NPI:1558751800
Name:GOLDENOAKS
Entity Type:Organization
Organization Name:GOLDENOAKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:520-378-3077
Mailing Address - Street 1:8099 S GEOFFRION ST
Mailing Address - Street 2:8099 GEOFFRION ST.
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9706
Mailing Address - Country:US
Mailing Address - Phone:520-378-3077
Mailing Address - Fax:520-378-3074
Practice Address - Street 1:8099 GEOFFRION ST
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615
Practice Address - Country:US
Practice Address - Phone:520-378-3077
Practice Address - Fax:520-378-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL4609H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility