Provider Demographics
NPI:1124668777
Name:GOLDEN OAK SENIOR SERVICES LLC DBA LEMOYNE PLACE
Entity type:Organization
Organization Name:GOLDEN OAK SENIOR SERVICES LLC DBA LEMOYNE PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:228-396-1998
Mailing Address - Street 1:14306 LEMOYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-9760
Mailing Address - Country:US
Mailing Address - Phone:228-396-1998
Mailing Address - Fax:228-396-2907
Practice Address - Street 1:14306 LEMOYNE BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-9760
Practice Address - Country:US
Practice Address - Phone:228-396-1998
Practice Address - Fax:228-396-2907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN OAK SENIOR SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility