Provider Demographics
NPI:1386375103
Name:GOLDSTAR ACADEMY OF HEALTH AND SCIENCES
Entity type:Organization
Organization Name:GOLDSTAR ACADEMY OF HEALTH AND SCIENCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-731-4174
Mailing Address - Street 1:115 S ACLINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2632
Mailing Address - Country:US
Mailing Address - Phone:843-316-9941
Mailing Address - Fax:843-329-7376
Practice Address - Street 1:115 S ACLINE ST STE A
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2632
Practice Address - Country:US
Practice Address - Phone:843-316-9941
Practice Address - Fax:843-329-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health