Provider Demographics
NPI:1699819334
Name:GOLDEN OPPORTUNITY HOME, INC
Entity Type:Organization
Organization Name:GOLDEN OPPORTUNITY HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-797-5154
Mailing Address - Street 1:PO BOX 9279
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9083
Mailing Address - Country:US
Mailing Address - Phone:910-488-8777
Mailing Address - Fax:910-482-4665
Practice Address - Street 1:6125 ACKERMAN DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-8813
Practice Address - Country:US
Practice Address - Phone:910-425-4463
Practice Address - Fax:910-482-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-762322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603501Medicare ID - Type UnspecifiedDMA PROVIDER NUMBER