Provider Demographics
NPI:1891328746
Name:GOLDEN MOMENTS HOSPICE, LLC
Entity Type:Organization
Organization Name:GOLDEN MOMENTS HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAGO GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-229-5248
Mailing Address - Street 1:650 N SAM HOUSTON PKWY E STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-5908
Mailing Address - Country:US
Mailing Address - Phone:832-312-7660
Mailing Address - Fax:
Practice Address - Street 1:650 N SAM HOUSTON PKWY E STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-5908
Practice Address - Country:US
Practice Address - Phone:832-312-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based