Provider Demographics
NPI:1992873889
Name:GOLDEN VALLEY MEMORIAL HOSPITAL HOME SERVICES
Entity type:Organization
Organization Name:GOLDEN VALLEY MEMORIAL HOSPITAL HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-885-8171
Mailing Address - Street 1:1600 NORTH SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735
Mailing Address - Country:US
Mailing Address - Phone:660-885-5088
Mailing Address - Fax:660-885-7756
Practice Address - Street 1:1703 N 2ND ST.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735
Practice Address - Country:US
Practice Address - Phone:660-885-5088
Practice Address - Fax:660-885-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263787905Medicaid