Provider Demographics
NPI:1609129469
Name:GOLDEN ACRE RESIDENTIAL CARE, LLC.
Entity Type:Organization
Organization Name:GOLDEN ACRE RESIDENTIAL CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:SARRACH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:734-620-3895
Mailing Address - Street 1:8253 STONEHAM DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6607
Mailing Address - Country:US
Mailing Address - Phone:734-547-5058
Mailing Address - Fax:734-547-5449
Practice Address - Street 1:8253 STONEHAM DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6607
Practice Address - Country:US
Practice Address - Phone:734-547-5058
Practice Address - Fax:734-547-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS82030507311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home