Active NPI
Golden Gate Manor Inc
Doing business as Golden Gate Manor 2
- Assisted Living Facility
- Pueblo, CO
National Provider Identifier
1417462185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 230654
- Legal business name
- GOLDEN GATE MANOR INC
- Doing business as
- Golden Gate Manor 2
- Practice address
- 1219 Lake Ave
Pueblo, CO 81004-2845 - Phone
- (719) 369-6290
- NPI assigned
- Dec 4, 2017
- Last updated
- Dec 4, 2017
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 230654 | CO | Primary |
| Respite Care | 385H00000X | 230654 | CO |
Addresses
Primary practice location
1219 Lake Ave
Pueblo, CO 81004-2845
Mailing address
1337 W Abriendo Ave
Pueblo, CO 81004-1005
Phone (719) 369-6290
Other names 1
- GOLDEN GATE MANOR 2
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2231765 | Golden Gate Manor II | Certificate of waiver | Aug 4, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Golden Gate Manor Inc
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Golden Gate Medical Supplies
- Durable Medical Equipment & Medical Supplies
- Pueblo, CO
- NPI 1437738093
Locations
1219 Lake 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": "1512345600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1512345600000",
"number": "1417462185",
"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": "1219 LAKE AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810042845",
"telephone_number": "719-369-6290"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOLDEN GATE MANOR INC",
"organizational_subpart": "NO",
"enumeration_date": "2017-12-04",
"last_updated": "2017-12-04",
"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": "230654",
"primary": true
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "CO",
"license": "230654",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "GOLDEN GATE MANOR 2",
"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 Dec 4, 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.