Provider Demographics
NPI:1679325336
Name:GOLDEN STATE ENTERPRISES LLC
Entity Type:Organization
Organization Name:GOLDEN STATE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HASHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-326-6607
Mailing Address - Street 1:1120 E APPALOOSA RD # RC
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3029
Mailing Address - Country:US
Mailing Address - Phone:480-326-6607
Mailing Address - Fax:
Practice Address - Street 1:1120 E APPALOOSA RD # RC
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3029
Practice Address - Country:US
Practice Address - Phone:480-326-6607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities