NPIMap

Organization Active NPI

Golden Triangle Living Centers Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Beaumont, TX
National Provider Identifier
1255445177
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
116341 Issued in TX
Legal business name
GOLDEN TRIANGLE LIVING CENTERS INC
Practice address
1760 Sams Way
Beaumont, TX 77706
Phone
(409) 860-4051
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 116341 TX Primary

Addresses

Primary practice location

1760 Sams Way
Beaumont, TX 77706

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
45G410MedicaidTX

Other names 1

  • Sams Way 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": "1255445177",
    "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": "1760 SAMS WAY",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "77706",
            "telephone_number": "409-860-4051",
            "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": "116341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45G410",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sams Way Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaumont, 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.