Golden Dream Residential Care LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

BH4619 Issued in AZ

Legal business name

GOLDEN DREAM RESIDENTIAL CARE LLC

Doing business as

N/a

Practice address

621 S 115TH Dr
Avondale, AZ 85323-9141

Phone

(623) 433-8189

Fax

(623) 433-9678

NPI assigned

Aug 21, 2015

Last updated

Aug 21, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William Ociti Marino

Title

Ower

Phone

(602) 299-9030

Specialties & licenses 1

Addresses

Other names 1

• N/A Doing business as

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1508233867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S 115TH DR",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853239141",
            "telephone_number": "623-433-8189",
            "fax_number": "623-433-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S 115TH DR",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853239141",
            "telephone_number": "623-433-8189",
            "fax_number": "623-433-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN DREAM RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "MARINO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "OCITI",
        "authorized_official_title_or_position": "OWER",
        "authorized_official_telephone_number": "602-299-9030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH4619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; 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.