Golden Road Behavioral Health SVC LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GOLDEN ROAD BEHAVIORAL HEALTH SVC LLC

Practice address

1700 E Desert Inn Rd Ste 304B
Las Vegas, NV 89169-3207

Phone

(702) 265-1112

Fax

(702) 442-8469

NPI assigned

Aug 15, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Malkia Lockett

Title

MGR/MG

Phone

(702) 980-2842

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Tax ID family

Golden Road Behavioral Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Golden Road Behavioral Health SVC LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1770059891
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ayasha Shamsud-Din

  • Mental Health Counselor
  • Las Vegas, NV
  • NPI 1124593546
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539648000000",
    "number": "1013497452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E DESERT INN RD STE 304B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693207",
            "telephone_number": "702-980-2842",
            "fax_number": "702-442-8469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E DESERT INN RD STE 304B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693207",
            "telephone_number": "702-265-1112",
            "fax_number": "702-442-8469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN ROAD BEHAVIORAL HEALTH SVC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-15",
        "last_updated": "2018-10-16",
        "status": "A",
        "authorized_official_last_name": "LOCKETT",
        "authorized_official_first_name": "MALKIA",
        "authorized_official_title_or_position": "MGR/MG",
        "authorized_official_telephone_number": "702-980-2842"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Golden Heart Wellness LLC
• Golden Home Care L.L.C.
• Golden Lake Care Home
• Golden Life
• Golden Miles
• Golden Road Behavioral Health SVC LLC
• Golden Soul Psychotherapy and Wellness
• Golden Sunshine Alzheimer'S Home Care, Inc.
• Golden Sunshine Alzheimers Care
• Golden Therapy Solutions LLC

• Community/Behavioral Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community/Behavioral Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.