Provider Demographics
NPI:1942885603
Name:GOLDEN PATH HEALTHCARE
Entity Type:Organization
Organization Name:GOLDEN PATH HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-748-2596
Mailing Address - Street 1:16891 W ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7040
Mailing Address - Country:US
Mailing Address - Phone:262-748-2596
Mailing Address - Fax:
Practice Address - Street 1:16891 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7040
Practice Address - Country:US
Practice Address - Phone:262-748-2596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health