Provider Demographics
NPI:1992184170
Name:GOLDEN EVOLUTION LLC
Entity Type:Organization
Organization Name:GOLDEN EVOLUTION LLC
Other - Org Name:NURTURING NEST MIHP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDYPULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-403-4576
Mailing Address - Street 1:15700 W 10 MILE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2149
Mailing Address - Country:US
Mailing Address - Phone:248-281-3477
Mailing Address - Fax:248-281-5487
Practice Address - Street 1:15700 W 10 MILE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2149
Practice Address - Country:US
Practice Address - Phone:248-281-3477
Practice Address - Fax:248-281-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care