Provider Demographics
NPI:1831540533
Name:GOLDEN ARMS ASSISTED LIVING LLC
Entity type:Organization
Organization Name:GOLDEN ARMS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:HILL-FORD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-493-3525
Mailing Address - Street 1:159 KAISER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8936
Mailing Address - Country:US
Mailing Address - Phone:601-493-3525
Mailing Address - Fax:
Practice Address - Street 1:1223 STEVEN WOOD RD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-4658
Practice Address - Country:US
Practice Address - Phone:601-786-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS163W00000X
MS310A0625X3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty