Golden Services Personal Care Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

092020021 Issued in GA

Legal business name

GOLDEN SERVICES PERSONAL CARE HOME

Practice address

930 W Magnolia St
Valdosta, GA 31601-3775

Phone

(229) 671-9020

NPI assigned

Jul 17, 2015

Organization subpart

No

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

Authorized official

Name

Mattie Blake

Title

Owner/Administrator

Phone

(229) 671-9020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1932583002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 W MAGNOLIA ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316013775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 W MAGNOLIA ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316013775",
            "telephone_number": "229-671-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN SERVICES PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "MATTIE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "229-671-9020"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "092020021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2124679828A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin Goff, CRNA
• Julia Hjort Goff, NP
• Lyndsey E Goff, OT
• Nikolay Gogin, MD
• Kristin Gayle Goin, LPC
• Stormi C Golden
• Wendy Golden, ED.S
• Albert Gonzalez-Acevedo, M.D.
• Heidi C Gonzalez, FNP-C
• Melody B Goodson, CCC - SLP

• Assisted Living Facility in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.