Provider Demographics
NPI:1952890212
Name:GOLDEN SHIELDS OF SOUTH CAROLINA INC
Entity type:Organization
Organization Name:GOLDEN SHIELDS OF SOUTH CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:770-380-8994
Mailing Address - Street 1:990 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-4023
Mailing Address - Country:US
Mailing Address - Phone:770-380-8994
Mailing Address - Fax:800-781-1997
Practice Address - Street 1:85 WADING BIRD LOOP
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-5906
Practice Address - Country:US
Practice Address - Phone:770-380-8994
Practice Address - Fax:800-781-1997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTERNATE PATHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No332900000XSuppliersNon-Pharmacy Dispensing Site
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care