Provider Demographics
NPI:1649816208
Name:GOLDEN TRACE HOMECARE LLC
Entity type:Organization
Organization Name:GOLDEN TRACE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:NKECHIYEM
Authorized Official - Last Name:NWABUEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-292-9005
Mailing Address - Street 1:25278 LAIRD KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3254
Mailing Address - Country:US
Mailing Address - Phone:832-876-3324
Mailing Address - Fax:
Practice Address - Street 1:25278 LAIRD KNOLL ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3254
Practice Address - Country:US
Practice Address - Phone:832-292-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty