Provider Demographics
NPI:1639315484
Name:GOA OPERATOR LLC
Entity type:Organization
Organization Name:GOA OPERATOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-661-7600
Mailing Address - Street 1:3145 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-2762
Mailing Address - Country:US
Mailing Address - Phone:251-661-7600
Mailing Address - Fax:251-602-9160
Practice Address - Street 1:3145 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-2762
Practice Address - Country:US
Practice Address - Phone:251-661-7600
Practice Address - Fax:251-602-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5526 (SCALF)310400000X
AL5524 (ALF)310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility