NPIMap

Organization Active NPI

Golden Gate Manor Inc

  • Assisted Living Facility
  • Pueblo, CO
National Provider Identifier
1174037006
Registry record updated Nov 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
230667 Issued in CO
Legal business name
GOLDEN GATE MANOR INC
Practice address
1033 E Evans Ave
Pueblo, CO 81004-2538
Phone
(719) 369-6290
NPI assigned
Nov 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2017

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

Authorized official

Name
Mark Harriman
Title
President
Phone
(719) 369-6290

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 230667 CO Primary
Respite Care 385H00000X 230667 CO

Addresses

Primary practice location

1033 E Evans Ave
Pueblo, CO 81004-2538

Mailing address

1337 W Abriendo Ave
Pueblo, CO 81004-1005
Phone (719) 369-6290

Other names 1

  • GOLDEN VALLEY Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2231770Golden Valley1033 E Evans, Pueblo, CO 81004Certificate of waiverAug 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Golden Gate Manor Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1033 E Evans Ave
Pueblo, CO 81004
Phone (719) 369-6290

NPI Registry JSON

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

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512000000000",
    "number": "1174037006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 W ABRIENDO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810041005",
            "telephone_number": "719-369-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 E EVANS AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042538",
            "telephone_number": "719-369-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN GATE MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-30",
        "last_updated": "2017-11-30",
        "status": "A",
        "authorized_official_last_name": "HARRIMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-369-6290"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CO",
            "license": "230667",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "CO",
            "license": "230667",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOLDEN VALLEY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.