Provider Demographics
NPI:1346067105
Name:GOLAN HOMECARE AGENCY
Entity type:Organization
Organization Name:GOLAN HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR,CEO
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUSI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-634-6708
Mailing Address - Street 1:9508 VIBURNUM DR
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9084
Mailing Address - Country:US
Mailing Address - Phone:757-634-6708
Mailing Address - Fax:
Practice Address - Street 1:9508 VIBURNUM DR
Practice Address - Street 2:
Practice Address - City:TOANO
Practice Address - State:VA
Practice Address - Zip Code:23168-9084
Practice Address - Country:US
Practice Address - Phone:757-634-6708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care