Provider Demographics
NPI:1518401777
Name:GOLDEN LIFE HOME HEALTHCARE INC.
Entity type:Organization
Organization Name:GOLDEN LIFE HOME HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FOOM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-322-0575
Mailing Address - Street 1:161 SAINT ANTHONY AVE # 927
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2382
Mailing Address - Country:US
Mailing Address - Phone:651-222-6245
Mailing Address - Fax:651-222-6242
Practice Address - Street 1:161 SAINT ANTHONY AVE # 927
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2382
Practice Address - Country:US
Practice Address - Phone:651-222-6245
Practice Address - Fax:651-222-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health