Provider Demographics
NPI:1962746438
Name:GOLD STREET CORPORATION
Entity type:Organization
Organization Name:GOLD STREET CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:USLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-532-4500
Mailing Address - Street 1:11 S WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4717
Mailing Address - Country:US
Mailing Address - Phone:209-532-4500
Mailing Address - Fax:
Practice Address - Street 1:11 S WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4717
Practice Address - Country:US
Practice Address - Phone:209-532-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty