Provider Demographics
NPI:1649862277
Name:GOLDEN ASSISTED LIVING LLC
Entity type:Organization
Organization Name:GOLDEN ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-468-3482
Mailing Address - Street 1:2107 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1823
Mailing Address - Country:US
Mailing Address - Phone:240-468-3482
Mailing Address - Fax:
Practice Address - Street 1:5126 CHALGROVE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5127
Practice Address - Country:US
Practice Address - Phone:443-449-5605
Practice Address - Fax:443-449-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD30AL3876OtherASSISTED LIVING FACILITY