Provider Demographics
NPI:1598082034
Name:GOLDEN BODYWORKER, INC.
Entity Type:Organization
Organization Name:GOLDEN BODYWORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:RMT
Authorized Official - Phone:303-278-1337
Mailing Address - Street 1:1300 JACKSON ST
Mailing Address - Street 2:SUITE # B 200
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1912
Mailing Address - Country:US
Mailing Address - Phone:303-278-1337
Mailing Address - Fax:
Practice Address - Street 1:1300 JACKSON ST
Practice Address - Street 2:SUITE
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1912
Practice Address - Country:US
Practice Address - Phone:303-278-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05-165-0233302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization