Provider Demographics
NPI:1487314274
Name:GOLDEN RECOVERY, LLC
Entity type:Organization
Organization Name:GOLDEN RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRAM DIRECTOR
Authorized Official - Phone:770-688-4625
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30292-0791
Mailing Address - Country:US
Mailing Address - Phone:770-688-4625
Mailing Address - Fax:678-688-4625
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-6209
Practice Address - Country:US
Practice Address - Phone:678-688-4625
Practice Address - Fax:678-688-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101Y00000XOtherDRUG TREATMENT