Provider Demographics
NPI:1699414219
Name:GOLDEN STAR RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:GOLDEN STAR RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HURIYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERBA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-716-4099
Mailing Address - Street 1:8143 IVYWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3277
Mailing Address - Country:US
Mailing Address - Phone:702-716-4099
Mailing Address - Fax:
Practice Address - Street 1:8143 IVYWOOD AVE S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3277
Practice Address - Country:US
Practice Address - Phone:702-716-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility