Provider Demographics
NPI:1124688312
Name:GOLDEN GUARDIANS CARE AGENCY, LLC
Entity type:Organization
Organization Name:GOLDEN GUARDIANS CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-GOWDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-626-5948
Mailing Address - Street 1:2542 SE OAKLYN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5228
Mailing Address - Country:US
Mailing Address - Phone:772-777-2381
Mailing Address - Fax:
Practice Address - Street 1:2542 SE OAKLYN ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5228
Practice Address - Country:US
Practice Address - Phone:772-777-2381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care