Organization
GOLDEN TRIANGLE LIVING CENTERS INC
Active
Other names
Model Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JERRINE B HARRELL (PRESIDENT)
(318) 445-6470
Entity
Organization
Contact information
Practice address
411 5TH AVENUE, PORT ARTHUR, TX 77642
(409) 985-4774
(409) 832-8044
Mailing address
2750 SOUTH 4TH STREET, BEAUMONT, TX 77701-7912
(409) 832-4112
(409) 832-8044
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
116213
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45H125
—
TX
Enumeration date
08/18/2006
Last updated
08/22/2020
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