NPIMap

Organization Active NPI

Golden Community Care Adult Family Home, LLC

  • Adult Care Home Facility
  • Spokane Valley, WA
National Provider Identifier
1164055091
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
GOLDEN COMMUNITY CARE ADULT FAMILY HOME, LLC
Practice address
12121 E Mission Ave Ste C
Spokane Valley, WA 99206-4832
Phone
(509) 443-3102
NPI assigned
Feb 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Mahoulome Harold GuidiNPI 1215499850
Title
Owner/Provider
Phone
(509) 280-7164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary

Addresses

Primary practice location

12121 E Mission Ave Ste C
Spokane Valley, WA 99206-4832

Mailing address

12121 E Mission Ave Ste C
Spokane Valley, WA 99206-4832
Phone (509) 443-3102

Other identifiers 1

IdentifierTypeStateIssuer
752707MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL goldencommunitycare@gmail.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1164055091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 E MISSION AVE STE C",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992064832",
            "telephone_number": "509-443-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 E MISSION AVE STE C",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992064832",
            "telephone_number": "509-443-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN COMMUNITY CARE ADULT FAMILY HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "GUIDI",
        "authorized_official_first_name": "MAHOULOME",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "509-280-7164"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "752707",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "goldencommunitycare@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12121 E Mission Ave Ste C",
            "city": "Spokane Valley",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992064832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.