Provider Demographics
NPI:1154852069
Name:GOLDEN PATH SERVICES
Entity type:Organization
Organization Name:GOLDEN PATH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-748-2596
Mailing Address - Street 1:1700 NORTH MAIN STREET
Mailing Address - Street 2:UPPER
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402
Mailing Address - Country:US
Mailing Address - Phone:262-229-8020
Mailing Address - Fax:
Practice Address - Street 1:1700 NORTH MAIN STREET
Practice Address - Street 2:UPPER
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402
Practice Address - Country:US
Practice Address - Phone:262-229-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========Medicaid