Provider Demographics
NPI:1255695961
Name:GOLDSTAR ADULT DAY CARE CENTER LLC.
Entity type:Organization
Organization Name:GOLDSTAR ADULT DAY CARE CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-306-4957
Mailing Address - Street 1:1712 HOPKINS XRD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2029
Mailing Address - Country:US
Mailing Address - Phone:612-306-4957
Mailing Address - Fax:763-546-7888
Practice Address - Street 1:1712 HOPKINS XRD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2029
Practice Address - Country:US
Practice Address - Phone:612-306-4957
Practice Address - Fax:763-546-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========Medicaid