NPIMap

Organization Active NPI

Golden Retreat Assisted Living

  • Assisted Living Facility
  • Hagerstown, MD
National Provider Identifier
1578884714
Registry record updated Jun 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
21ALOO95-A Issued in MD
Legal business name
GOLDEN RETREAT ASSISTED LIVING
Practice address
673 Highland Way
Hagerstown, MD 21740-6287
Phone
(301) 393-3609
Fax
(301) 393-8045
NPI assigned
Jun 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2010

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

Authorized official

Name
Ms. Paulette Marian Crockett
Title
Owner/Manager
Phone
(301) 393-3609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 21ALOO95-A MD Primary

Addresses

Primary practice location

673 Highland Way
Hagerstown, MD 21740-6287

Mailing address

673 Highland Way
Hagerstown, MD 21740-6287
Phone (301) 393-3609

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1578884714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 HIGHLAND WAY",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406287",
            "telephone_number": "301-393-3609",
            "fax_number": "301-393-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673 HIGHLAND WAY",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406287",
            "telephone_number": "301-393-3609",
            "fax_number": "301-393-8045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN RETREAT ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-22",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_middle_name": "MARIAN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "301-393-3609",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "21ALOO95-A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; 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.