Provider Demographics
NPI:1265868525
Name:GOLDEN VALLEY CORP
Entity type:Organization
Organization Name:GOLDEN VALLEY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDALIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-244-2757
Mailing Address - Street 1:PO BOX 801529
Mailing Address - Street 2:COTO LAUREL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00660
Mailing Address - Country:UM
Mailing Address - Phone:787-244-2757
Mailing Address - Fax:
Practice Address - Street 1:AVE TITO CASTRO 606
Practice Address - Street 2:LA RAMBLA PLAZA SUITE 217
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-244-2757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies