Provider Demographics
NPI:1265260814
Name:GOLDEN HAVEN ASSISTANT LIVING LLC
Entity type:Organization
Organization Name:GOLDEN HAVEN ASSISTANT LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NKASIOBI
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:ELENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-521-2877
Mailing Address - Street 1:1026 MANUEL DR
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0358
Mailing Address - Country:US
Mailing Address - Phone:682-521-2877
Mailing Address - Fax:
Practice Address - Street 1:1026 MANUEL DR
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75087-0358
Practice Address - Country:US
Practice Address - Phone:682-521-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities