Provider Demographics
NPI:1699050971
Name:GOLDEN GATES HOMECARE AGENCY, LLC
Entity type:Organization
Organization Name:GOLDEN GATES HOMECARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-388-6976
Mailing Address - Street 1:200 VALENCIA DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6311
Mailing Address - Country:US
Mailing Address - Phone:910-388-6976
Mailing Address - Fax:
Practice Address - Street 1:200 VALENCIA DR
Practice Address - Street 2:SUITE 165
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6311
Practice Address - Country:US
Practice Address - Phone:910-388-6976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4466251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care