Provider Demographics
NPI:1427242312
Name:GOLDEN GIRLS RESIDENTIAL LIVING
Entity type:Organization
Organization Name:GOLDEN GIRLS RESIDENTIAL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERLA MANAGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ILUMINADO
Authorized Official - Middle Name:LANDOY
Authorized Official - Last Name:CALISANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-414-3004
Mailing Address - Street 1:6827 W ROWEL RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7040
Mailing Address - Country:US
Mailing Address - Phone:623-414-3004
Mailing Address - Fax:623-414-3771
Practice Address - Street 1:6827 W ROWEL RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7040
Practice Address - Country:US
Practice Address - Phone:623-414-3004
Practice Address - Fax:623-414-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5905310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility