Provider Demographics
NPI:1699127639
Name:GOLDEN LIFE FAMILY CARE HOME, LLC.
Entity type:Organization
Organization Name:GOLDEN LIFE FAMILY CARE HOME, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CRATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-208-8479
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-0674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 WESTMINSTER LN
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-2766
Practice Address - Country:US
Practice Address - Phone:252-208-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN LIFE FAMILY CARE HOME, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL054072251J00000X, 251K00000X, 253J00000X, 253Z00000X, 292200000X, 3104A0625X, 311ZA0620X, 3140N1450X, 335G00000X, 385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No253J00000XAgenciesFoster Care Agency
No292200000XLaboratoriesDental Laboratory
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No335G00000XSuppliersMedical Foods Supplier
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp