Provider Demographics
NPI:1952829202
Name:GOLDEN ACRES ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:GOLDEN ACRES ASSISTED LIVING FACILITY
Other - Org Name:PATTEN BLANKS HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CARNES
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:251-473-0700
Mailing Address - Street 1:1111 E I65 SERVICE RD S STE 106
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3101
Mailing Address - Country:US
Mailing Address - Phone:251-473-0700
Mailing Address - Fax:847-388-4848
Practice Address - Street 1:6411 HOWELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-3120
Practice Address - Country:US
Practice Address - Phone:251-473-0700
Practice Address - Fax:847-388-4848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATTON BLANKS HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251J00000X, 261QA0005X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC65259050862OtherDRIVERS LICENSE