NPIMap

Organization Active NPI

Golden Triangle Living Centers Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Port Arthur, TX
National Provider Identifier
1164536082
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
116213 Issued in TX
Legal business name
GOLDEN TRIANGLE LIVING CENTERS INC
Practice address
411 5TH Avenue
Port Arthur, TX 77642
Phone
(409) 985-4774
Fax
(409) 832-8044
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Jerrine B Harrell
Title
President
Phone
(318) 445-6470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 116213 TX Primary

Addresses

Primary practice location

411 5TH Avenue
Port Arthur, TX 77642

Mailing address

2750 South 4TH Street
Beaumont, TX 77701-7912
Phone (409) 832-4112

Other identifiers 1

IdentifierTypeStateIssuer
45H125MedicaidTX

Other names 1

  • Model Living Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Golden Triangle Living Centers Inc34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164536082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 SOUTH 4TH STREET",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777017912",
            "telephone_number": "409-832-4112",
            "fax_number": "409-832-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 5TH AVENUE",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "77642",
            "telephone_number": "409-985-4774",
            "fax_number": "409-832-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN TRIANGLE LIVING CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JERRINE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-445-6470",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "116213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45H125",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Model Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Arthur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.