Provider Demographics
NPI:1942070347
Name:GOLDEN HAVEN SENIOR LIVING LLC
Entity Type:Organization
Organization Name:GOLDEN HAVEN SENIOR LIVING LLC
Other - Org Name:GOLDEN HAVEN SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-305-4408
Mailing Address - Street 1:809 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-6013
Mailing Address - Country:US
Mailing Address - Phone:331-305-4408
Mailing Address - Fax:
Practice Address - Street 1:809 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-6013
Practice Address - Country:US
Practice Address - Phone:331-305-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility