Provider Demographics
NPI:1710352596
Name:GOLDEN LIVING
Entity Type:Organization
Organization Name:GOLDEN LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-495-6533
Mailing Address - Street 1:925 S OXFORD AVE
Mailing Address - Street 2:B2
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3907
Mailing Address - Country:US
Mailing Address - Phone:920-495-6533
Mailing Address - Fax:
Practice Address - Street 1:925 S OXFORD AVE
Practice Address - Street 2:B2
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3907
Practice Address - Country:US
Practice Address - Phone:920-495-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2389-19314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility