Provider Demographics
NPI:1558168146
Name:GOLDEN GATE CARE LLC
Entity type:Organization
Organization Name:GOLDEN GATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:505-718-9829
Mailing Address - Street 1:149 SPECTRUM AVE SW
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1888
Mailing Address - Country:US
Mailing Address - Phone:505-520-5640
Mailing Address - Fax:
Practice Address - Street 1:149 SPECTRUM AVE SW
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1888
Practice Address - Country:US
Practice Address - Phone:505-520-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health